why are we asking for health care reform?
Reading Reihan’s post on the costs of health care reform today gave me what has become a very familiar feeling.
Reihan’s post is well reasoned and written. I agree with him that health care reform will be expensive, and I also agree that we will all have to pay more in taxes to solve the problem– although it needs to be said that there are, in fact, many places we could cut costs in our system, that our system is hideously inefficient, and that the idea that we might be able to save some money in the long run isn’t some liberal pipe dream conjured up to rob Ma and Pa American of their health care but the honest and well-argued opinion of a lot of very smart people. I think Reihan is thinking about this in a constructive way. But he’s not talking about it in a fair way, and neither are his peers.
Why? Because many conservative blogs, from all the various strata of the ideology, have been doing a very poor job of frankly acknowledging the enormous amount of human suffering our health care system causes.
There are very many people, in this country, who need health care and are unable to get it, because of their financial or employment situations. This is a fact, and it is unavoidable. The number of people so afflicted is a matter of great controversy. A great amount of virtual ink has flowed for the purpose of taking shots at the various quoted figures of the uninsured and the underinsured. And who can say, exactly. But it is a great many people. It is millions; even the most rabid partisan must acknowledge that millions of people in this country lack adequate health care coverage. Millions of people, in the country with the most powerful economy in the history of the world, cannot access desperately needed health care because they can’t afford to.
Our system leaves people suffering. Americans, today, don’t go to the doctor because they can’t afford to, though they are in pain, often debilitating pain. Our system leaves people in financial ruin. Those who are uninsured or underinsured and face major medical conditions are often left with bills that leave them destitute, bankrupt, or both. The numbers, again, are controversial. Whatever they are, they are again real, and again large. Our system also kills people. Prevention and early diagnosis are the foundations of Western medicine. People don’t go to the doctor, when they can’t afford it, and they don’t get early diagnosis, they don’t get early intervention, and they don’t get help until it is too late to avoid permanent injury or death.
The factual accuracy of this basic picture– in this country, there are very many people incapable of affording health care, and it often has dramatic negative effects on their lives– is not in dispute.
None of this is the end of the story. For many, it is not even the most important part of the story. I’m not trying to argue that it has to be, although as for myself, it is. What I am arguing is that it is a part of the story, and one which must be acknowledged by anyone who wishes to weigh in on the subject in a morally responsible way. I am not asking for over-the-top apologetics. What I am asking for is acknowledgment, for admission that there are profound reasons for wanting to enact sweeping changes in the way we dole out medicine. There’s been a lot of scolding, from those opposed to health care reform, that those in favor of it are leaving out a key part of the discussion, and are arguing irresponsibly. I believe they might be right. But I am asking them to turn that same discriminating gaze back on themselves and to ask whether they are arguing in a way that ignores the basic human costs that inspire a desire for health care reform in the first place, or worse, in a way that ends up belittling the many victims of our system out of conviction that health care reform is unneeded or out of simple partisan zeal. I don’t expect my many antagonists to believe me when I suggest that to them. I do ask them to ask themselves.
I believe that for people in the most powerful economy in the history of the world to lack for access to health care is an obscenity. I believe it makes folly of our claims to be a moral nation and undermines the very notion of democratic community. I don’t expect people who don’t agree to change their minds. But we are not asking this for no reason; we are asking this because of real and devastating suffering. Even I don’t believe that this suffering is the only meaningful part of the discussion. I know in my heart that a discussion that fails to interrogate it as an essential fact is as useless as it is immoral.
Update: To head off a criticism– this is not an argument about not caring. There is no question in my mind that Reihan cares a great deal about the plight of the uninsured. There’s no question in my mind that most who argue against health care reform care. This is an argument about a distended policy discussion, and the efficacy of a conversation in which key information too often goes unsaid.
“Because many conservative blogs, from all the various strata of the ideology, have been doing a very poor job of frankly acknowledging the enormous amount of human suffering our health care system causes.”
Perhaps they have a different idea of how much human suffering is entailed with being alive in the first place and, instead, look at what is being prevented rather than what is being caused.Report
Perhaps they have a different idea of how much human suffering is entailed with being alive in the first place and, instead, look at what is being prevented rather than what is being caused.
Oh, then. By all means, continue.
Do you think that they will be damned to the marsh where the angry and sullen go, or will they make it all the way to the ninth circle reserved for those who betray their benefactors?Report
So do you stick to the same logic with, say, the fire department? “Hey, that guy’s house is on fire!” “Well, life’s tough….”Report
It is not inevitable that a house catch fire.
I guarandamntee you that you will need a prescription after you hit age 70. Why is that?
Well, in the case of the house, there are houses that have existed for hundreds of years without burning down… fire is not inevitable.
But people? Every single (EVERY SINGLE) one of them is going to die. No matter how much money we spend. Even if we spend all of it.Report
The poor are *meant* to suffer, you see. It is their lot in life. Just as it is the heavy burden of the rich to pay for their superior health care.
So Reihan’s not allowed to weigh in on the politics of health care unless he begins with a public show of tears and hand-wringing? Give me a break. He – like any sane conservative or libertarian – understands that the current system is broken, and indeed is explicitly advocating for reform. He just doesn’t think that Obama’s proposal is the best way to do this, and he also thinks that in the long run the crushing burden of unpayable debt would do no good at all for anyone. And these, too, are the honest and well-argued opinions of a lot of very smart people. This constant imputation of heartlessness and bad faith is getting old.Report
But I’m not imputing bad faith, John, and your constant straw-manning of me is getting older. Seriously, I don’t know what has inspired your jihad against me, and frankly, I don’t care– whatever message you’ve intended to send, you’ve sent. Fear not.
By the way, you’re among the worst at this. To read your posts on health care, one would think there was simply no reason at all anyone would advocate reform. I can’t understand someone having such antipathy for movement conservatives but at the same time being so animated by the same thing, utter disregard for liberals.Report
That’s demonstrably false, Freddie; I am absolutely in favor of reform and have said so often, but I just don’t think that the way to do that is to make health care free.Report
This is what set me off. Reihan is the author of a book that has (I think) an entire chapter devoted to health care reform, and he and Ross make it quite clear that they think the present system isn’t meeting people’s needs. The same goes, I think, for the NR symposium on health care that was published the other month. Not being in favor of a heavily state-run system does not at all mean the same thing as not being in favor of reform, and so obviously doesn’t require insufficient recognition of the suffering caused by the current system.Report
Thanks for this post, Freddie. What you describe is something I witness daily. Our current health care system (if it can be accurately described as such) is constantly forcing people to choose between care they or their loved ones need, and other basic necessities. However one would address the problem, the suffering involved must be acknowledged.Report
But…Reihan and John Schwenkler are talking around the 800 pound gorilla in the room……nat’l healthcare is very bad juju for the GOP.
Small gov’t meant local welfare providers like churches took care of the electorate. Big gov’t welfare means increasing secularization, and addiction to liberal welfare.
The problem for Reihan, is that his audience wants nat’l healthcare, and doesn’t have the IQ substrate to absorb why that is a bad idea.
It is the same old problem.
There are good reasons for conservatism….just none that the left side of the bellcurve is capable of understanding.Report
“nat’l healthcare is very bad juju for the GOP.”
Bad juju for all of us…we don’t need no stinkin’ Great Society II!!…or Vietnam II!Report
Well hm. Ya’ll should have thought about that in 2003.Report
read and tell me about the wonders of the free market and how insurance companies are the solution to health care.Report
Caring is not the issue. Oh, it’s involved, and I don’t think imputing not caring on someone is the blood libel you seem to think it is– but then, I didn’t accuse Reihan of not caring. Not explicitly, and not implicitly. I am not shy. And I’m not afraid to say socially unpleasant things if I think they’re righteous. If I thought that Reihan was uncaring, I would say so; I’d even say it to his face.
What I do think is that Reihan is wrong, as a matter of process, to not be more up front in that particular post about the costs of health care. And it is connected to a great frustration with this debate, where I read and read and am amazed. Because someone coming to the discussion fresh might not have any idea, any idea at all, about why we would want to reform health care at all. Even if they did, they’d think these were purely cost saving measures and nothing more.
There are aspects of my life that are not meant for blogging and which I don’t share. But suffice to say that I have met a person who had teeth rot out of his mouth because he didn’t have dental care. I have met a woman who ignored her abdominal pain for lack of insurance, only to learn she had cancer, and could have vastly improved her chance for survival if she had sought help earlier, as she would have done had she been insured. I have met someone who endured days of agony over a simple sprain, because without insurance to copay the choice was between pain medication and rent. Those are three people; picky any of thousands and thousands. No one denies these stories exist. And, as you allude, few think that they should continue.
And yet the urgency of this issue cannot be stressed because it is considered somehow impolite to mention such things. Because being Very Serious means eliding entirely the actual reason why health care reform is imperative and focusing on the only thing responsible adults are supposed to care about, money and efficiency. That neuters the arguments of those who feel compelled by conscience to change our system. I need to talk about those things, and if the result is that Reihan or someone similar might misinterpret talking about such things as a suggestion that he’s uncaring, so be it, I guess.
Now I don’t want to have a constant appeal to emotion, which is why I try to keep such anecdotes to a minimum when I talk about this issue. But to excise the human need from a conversation about human need does no one any favors and inevitably privileges those who support the status quo. What I find tedious is the idea that I have to assume at every instance that unless I specifically say “I’m not insulting you,” I’m insulting someone. I care about and respect Reihan, and you, John, but I’m not about to stop talking about what I consider the moral reality of the situation. If you disagree about either my take on that reality, or the best way to fix it, by all means, fire away. But I’m not attacking people for caring. This issue is bigger than caring.Report
And does being Very Morally Serious mean eliding any considerations about which among the many possible reform proposals would actually work?Report
Government intervention has played a large role in the state of healthcare and its present cost. The choice is not between accepting a costly, broken healthcare system or accepting a government plan to control even more of healthcare. That’s a false choice. Another choice is between using free market principles as a means of reform rather than simply allowing government to control the reform without considering the free market at all. This latter choice recognizes the cost of the present system and offers another possible avenue of reform. If we stopped to consider the viability of free market solutions rather than assume the only answer is government control, we’d be doing even more to help resolve the problem.
So, actually, those who are insisting on one avenue of reform, government control, are limiting the possibilities of reform, therefore more a part of the problem than those who are not limiting the search for a solution. I think many people who are skepical of turning healthcare completely over to government are saying — Let’s also look at how free market principles can play a role — this widens the possibilities for reform, if reform is the goal.
Obama’s idea of adding a public choice as a means of helping competition in the free market is a cynical approach to free market principles and actually undermines the market. It doesn’t follow that from understanding the underlying principles involved in order to reach the best solution to fix a broken system this entails a denial of present costs and consequences — that’s a non sequitor.Report
Insurance companies have nothing to do with any free market, never did, so the only way to increase competition would be to abolish all healthcare not purchased directly by the patient. Which would I think do far more to stifle the very-much lauded (and currently, very heavily subsidized) “innovations” of our system so often given as an excuse against reform. Quality for everyone will decrease to a level that people can actually afford. I think that will be a hard sell.Report
Quality for everyone will decrease to a level that people can actually afford.
Joseph – I think this hits the nail on the head. A truly free market solution will decrease the quality of health care if it is ever to achieve the goal of universal coverage.Report
And what do you think a state-run system will do if it’s going to achieve that goal without blowing up the economy?
It’s simply not possible for everyone in America to have the highest-quality health care at all times.Report
I don’t know if it’s a matter of key information being left out as it is a natural result of shoddy argumentation.
After all, people on both sides of many issues have a tendency to emulsify methods and goals, though one can reasonably agree with the either not necessarily both.
How many conservatives are tired and frustrated of hearing how anti-poor they are because of their fiscal conservatism? How many liberals feel similarly about hearing how anti-America/the Troops they are because of their views on the GWOT? An incalculable number, perhaps.
We are tired and frustrated. Tired of being presumed to argue in bad faith. Frustrated with being selectively heard. We’re tired and we’re quick to presume bad faith in others because it’s easier. It’s what we’ve been taught. It’s what everybody else is doing. I could be totally wrong here, but this is my view/read of where political discourse in America is.
I’m writing too many words to say this but I think you’re right, Freddie, and make a good point. I just don’t think the solution is to stress something that isn’t recognized enough.
After all, What’s the point of stressing shared goals but different methodologies, if the latter obscures the former to the point of non-existence. If we’ve been taught to expect that such recognition will be treated as political theatre, disingenuous, shear lunacy, or some other expression of presumed bad faith, what’s the point of saying something that nobody will listen to or even believe?
Perhaps the answer here isn’t to talk, but to listen. To recognize our solidarity with those who share our goals and concerns but not necessarily all of our methods.Report
Mike- I think many people believe the free market has failed. Noting that government has been involved in health care is used a get out of fail card to ignore the problems in health care. For my money there are systems, Germany most notably, they do not have any public option yet still manage high quality universal care. But when you start with talking about the free market it appears your focused on the free market first. If the government doesn’t’ establish a minimal floor of care for all , who will? If the gov doesn’t make it a goal that all have care, then who will? If the gov doesn’t outlaw the most egregious practices of insurance companies, who will?
This is a personal value statement, but people come before profits. That should be the beginning of the discussion of health care.
Some of the sad facts of the health care “market” is that many people with chronic illnesses or cancer and such will never be profitable for insurance companies. It is easy for people to rack up bills in the hundreds of thousands. That is a fact of the insurance market. And there is little incentive for insurance companies to pay for preventative care if they do not plan on covering a person for many years. I have been told a couple time “sorry we don’t pay for that. It’s preventative care.”Report
“But when you start with talking about the free market it appears your focused on the free market first. If the government doesn’t’ establish a minimal floor of care for all , who will? If the gov doesn’t make it a goal that all have care, then who will? If the gov doesn’t outlaw the most egregious practices of insurance companies, who will?”
The government doesn’t create wealth then distribute it to people in need. The government confiscates wealth and redistributes it. You simply don’t believe in voluntary benevolence — you are focused on the government as the only source of benevolence. Besides, if we absolutely insist on going through a middleway to express benevolence — the government — then why not just let government provide healthcare to the ones who can’t afford it, then keep government out of the rest? As I stated before, although it was misconstrued, private donations in the US to foreign aid is higher than what other countries give. We are a rich, generous nation. Private charity would be much more efficient in healthcare than government efforts, and it would more humanely cover those who can’t afford healthcare. Seeking innovative private solutions should be the first way we attempt to solve the problem, using government only for what the private sector can’t handle — an emercency backstop. Removing all the stifling regulations would allow the possibility for the market to address the problem. Profits are immaterial if people are able to access what they need, besides, the government will have to be responsive to the costs just like a private company, and the overhead costs in bureaucratic bloat and waste will be greater than any profits made by private concerns. Most people think that a government controlled solution will mean they don’t have to pay anything for healthcare — this is the seduction — but people will have to pay, dearly, somewhere down the line — many will pay by being unemployed.Report
Here’s a good article — http://www.cafehayek.com/hayek/2009/06/rational-rationing.html
You simply can’t deny the consequences of past government involvement in healthcare by accusing opponents of dishonestly using the consequences as a “get out of fail card to ignore the problems in health care”. I think we’re honestly assessing the problems in healthcare by taking the government’s past, heavy-handed intervention into account.Report
M.F. , excellent stuff, very well done; rational, common sense, ect. much appreciated.Report
Governments quite clearly can provide health coverage to all – some form of socialized medicine works in nearly all other fully modern nations. To argue otherwise is to ignore the facts. What’s more, costs are far lower on a per capita basis than in the US, even though we don’t actually provide health care for, what, 40 million people?
Freddie is actually too kind to Reihan – i don’t like to impute bad faith to people, it is too cheap and too easy, but willful blindness, that is nearly universal amongst human beings. What proposals have we seen that even
The GOP has no plan to fix health care. The free market is not an answer, clearly, because there is no such thing as a free market for health care and never has been. Probably can’t be – anytime you have a “must purchase now” on the weak side of the power balance, any concept of free has been left behind. It is chimera, a hodgepodge of powerful forces allied in their self interest with the consumer being little more than a source of wealth.
When Reihan says this, “Recognizing that he might never be as popular as he is right now, Obama is eager to do what Truman and LBJ and Clinton couldn’t by fulfilling the New Deal vision of universal health care as a cornerstone of the American welfare state.” in his Daily Beast article he betrays his position clearly – universal health care is a bad. If that is your starting position, as it appears to be Reihan’s, then you don’t deserve Freddie’s good will. You deserve condemnation.
Riehan offers no suggestions for a “smart, sane, cheap alternative” because he knows that there is no such thing. There is only political obstruction the aim of which is to thwart universal healthcare.
Read his BOOK, Jake.Report
Mike, again– you say a lot of very smart things about health care reform. What you are failing to tell me is a way that people who are unable to afford it are going to get it. Perhaps entirely removing government from medicine will drive down the cost of needed services, and market reforms will help make health care more affordable. But I’m not hearing how people who would be able to afford even cheaper health care are going to get it.Report
I don’t think that any serious participant in this debate is denying the need for financial assistance for those who can’t afford health care; McCain, for instance, proposed (perhaps insufficiently) to deal with this through issuing vouchers. (Redistribution!) Another proposal in the vicinity, which wouldn’t exclude the voucher option, would be to cap total out of pocket health care expenses at a certain percentage of household income. Or we could do away with some of the more draconian licensing requirements and so enable a flood of much cheaper options to be available to the poor. And so on. The idea that we should “entirely remove government from medicine is a red herring”; the question is whether having it involved in less heavy-handed and intrusive ways would more effectively deal with the relevant issues.Report
I linked, approvingly, to a Will Wilkinson bloggingheads segment last week where he said that his plan would be simple: when people can’t afford health care, the government cuts them a check. And you know what? I’d be 100% onboard with that plan, if it’s the option that delivers coverage to the most people.
I’m not a wonk. I try to be aware of my numerous limitations. So I let the smarties tell me what the best program from an efficiency standpoint would be, but I remember my duty to support a plan that provides universal coverage. It’s precisely because I know Reihan does care that I am frustrated that he isn’t a little more upfront about the costs of the status quo. I’ve read GNP twice, and while it’s not my vision of a new health care plan, it is a vision. What I am trying to stress is that peoples’ houses are on fire, and that while we dither endlessly about the best way forward, we leave them with no recourse. I don’t want use to act recklessly. I do want us to act with urgency, and currently, we are moving in such a way on this issue that seems to presume that time is on our side. And I don’t think it is.Report
Mike, I do believe in voluntary benevolence having worked at private charities. But charities have severe limitations. In tough times donations go down. They have to constantly beg for money. They are dependent on what people will give so they often cannot do what is needed. They are limited by there donation base so many areas have no charity based services. Nice idea, completely impractical.
All i’m hearing is the same buzzwords without any explanation of how they apply to health care. So how do people with preexisting conditions get health care? Who makes sure everybody has coverage?
And i do think the free market has failed. A lot of the gov invovlment has been to give people health care who don’t have it. You can’t just blame the gov for everything. uhhh wait nevermind.Report
The government involvement has also involved driving up the cost of health care through ludicrous licensing requirements, unnecessary mandates, hugely distortionary policies like the tax credit for company-sponsored health insurance, and so on. No, it’s not to blame for everything, but it is to blame for a lot.Report
The government involvement has also involved driving up the cost of health care through ludicrous licensing requirements
The government is massively involved with our current health care system. They provide health care to young, the ridiculously poor, and the elderly. They provide the tax breaks which created the employer based health plans. They provide millions in grants for medical R&D. But the government has been kept from using their considerable influence to lower costs on the private side in any meaningful way.
So what we have right now is the worst of both the private and the government worlds. The government pays a crap ton, but the private industry keeps getting to pocket all the profits while not providing better or more coverage.
Unfortunately, I don’t think a truly private system will ever work anymore. Advances in genetic research and data collection have made it very easy for insurance companies to drop risky patients that threaten their bottom line, which means we’re moving to the point where health insurance will only be offered to those who don’t really need it.
Also, the desire for profits runs completely counter to the idea of medical care. Sure we don’t want government bureaucrats deciding what care we get, by why do accept private industry accountants in that same role?Report
It seems like several of you did not read what I wrote and went directly back to your biases. If you’d respond to what I actually wrote, it would be much easier to have a discussion. Instead of automatically shutting out any market ideas, consider the possiblity of a combination of charity and government safety net when, or if, charity fails, like I stated. However, “charity” is a loaded word, because liberals think it takes away dignity. So, just think of it as private, dignified welfare with the government kicking in when it’s insufficient. I can almost garauntee, though, that private welfare would always be sufficient in the 21st century, especially if government’s heavy burden is lifted from businesses and the economy achieves what it’s capable of achieving — we would be swimming in prosperity, if businesses are allowed to do business. I believe this is the route we will have to go when government collapses under the weight of it’s inability to handle all the responsibilities it’s assigning to itself. It might take another 10 years, but I believe we’ll see more and more private options in order to make our benevolent efforts efficient and effective. So, Freddie, helping the poor is possible outside Washington control — really, it is.Report
But Mike, I did read what you said. You say not only government can help the poor. True. I am asking for a guarantee of coverage, and that, I’m afraid, only government can provide.Report
How has that guarantee worked out historically?
Did “The Poor” benefit from Johnsons’ War On Poverty or was “The Poor” damaged by it?
If there is reason to believe that more harm was done than good (and there is), why is it not fair to ask whether this plan will be different despite its best intentions?Report
Jaybird – I don’t know about you, but I prefer to work in a country that has limits on work hours and regulates to some degree what employers can do and demand. I’m glad we have child-labor laws. I’m glad we aren’t the way we were in industrialized 19th century America. Some of that has to do with progress the government has made, believe it or not….Report
Jaybird, there are several countries in the world who deliver universal health care coverage, and some of them do so while providing a very high quality of coverage. I want the same, and I am tired of being told that this country, with all its power and abundance, is incapable of attaining that.Report
I’m not saying it’s incapable in theory.
I’m just saying that it’s about as likely as other big-government programs to achieve the things they set out to do.
For example: Johnson’s War On Poverty.
If I were to tell you that universal health care was as likely to be about as expensive as the WOP and about as successful, would you see it as something we should totally do or something that, hey, well… maybe we should hold off?Report
John, here is Reihan speaking about his book in a post at The American Scene about Ezra Klein’s take on GNP “… there is something to this — our goal was to start a conversation, not to end it.” That was a year ago. I find nothing (readily) that suggests what Reihan now believes are sane ideas. Okay, one idea – it should be piecemealed. Hmmmmm. Pretty deep, that.
John, if Reihan can’t do it, maybe you can point to an actual policy proposal providing for universal coverage put forward by someone, anyone, who you consider to be a conservative.
Huh? You mean aside from the dozen or so that Reihan proposes in his book? How dense are you, Jake?Report
And P.S. Reihan’s point in that post, at least as I recall, was that it was with an eye to starting rather than ending a conversation that they’d made multiple (sane, actual, etc.) proposals, rather than endorsing just one as their clear preference.Report
John, were any of those policies taken up by conservatives? Are they being voiced TODAY? Reihan’s book is more than a year old.
I don’t disagree with your assessment of Reihan’s statement – my point was that he intended to start a discussion of sane policies, and I see no evidence sane policies are being put forward by conservatives. All I hear is how everything costs too much. That’s a policy, and it is a sane one – if you adopt the position that universal health care is not an end that should be pursued.
I think that McCain’s proposal was very much in the spirit of Ross and Reihan’s ideas, so (without making claims about the direction of influence) yes.
I don’t follow this at all. If health care costs too much, then universal coverage will be impossible. But in any case I don’t see why universality per se should be the desideratum; what matters is universal affordability, and in fact there’s reason to think that mandates would actually make that less possible, not more so.Report
John, universal affordability would be fine with me – as long as everyone was required to participate. As it is now, we do pick up costs for the uninsured – emergency room costs, if nothing else. Often, though, we as taxpayers and insurance consumers (is that some kind of oxymoron?) pay for hospitals providing care for which payment is never made. If everyone uses the system sooner or later, then everyone should pay.
However it is done, and I do not believe a free market can work where the power is all on one side of the table, in this case the provider/hospital/insurer side, i believe it should be done. Let’s see some genuine proposals from conservatives.
Presuming you meant John McCain (and if his take on Iran didn’t alarm you, then I am talking to the wrong John 🙂 his plan was tax credits, increased competition amongst insurers, and taxing employer plans. McCain offered up a $5k tax credit for a family. Interestingly enough, that amount might actually be more than the income tax burden on the median family in the US. Median family income in the US in 2007 was around $50k. The Fed income tax burden? Something under $2000 or less, and even less under Obama’s tax plan. So a $5k tax credit will not help anyone not paying at least $5k in Fed income tax. The next point is what does insurance cost? The latest I heard was around $11k or $12k annually for a family for employer plans – whether they are good plans or not I have no idea. So to to provide insurance to the uninsured, most of whom don’t make more than the median and so play little or no income tax at all, we are going to give a $5k tax break they can’t use then hope that insurance for individuals will be somehow lower than existing employer plans, which cost only $11k or $12k annually. Is that the plan to which you refer? Maybe you mean RSM, I don’t know.
McCain’s plan goes on to include risk pools for the really sick – that is an oxymoron – as well as limits on what insurance costs and assistance for those who simply can’t afford health insurance (almost everyone below the median). I would characterize this as Reihan’s piecemeal approach – and yet when you get down to it, the gov does almost all the work – the risk pools (guaranteed access), the assistance, the limits. If I step back, it almost looks like he’s protecting the insurance companies, not the un and underinsured. And then McCain says this will cost only $10 billion, I assume annually, as compared to total health cares costs in excess of $2 trillion. That is so unrealistic as to be laughable.
McCain’s pre-election objections to the Democrats plans consisted of too expensive and too much government. Expensive could be, but McCain’s plan had just as much government in it as any other plan. Government action is the only thing holding his plan together.
Is McCain’s idea the only one out there? Do you actually consider him a conservative, even a fiscal one?
I think that’s an awful idea; individual mandates are a perfect way to give the medical industry a chance to require people to pay for services that they don’t want or need.
Again, see Ross and Reihan’s book for a start. Or see any of the dozens of health care wonks at NRO, Cato, and so on. I make no apologies for the incompetence of the Republican Party.
I think this is based on a misunderstanding of the mechanism; refundable tax credits can be used to give people back more than what they paid in taxes.
Yes, but part of the reason that they’re so costly is because they aren’t taxed, so individuals don’t actually face up to the plans’ real costs; hence part of the impetus behind a plan like McCain’s was to create market incentives to help drive the cost of health insurance down.
How in the world do you get that, when the plan includes tax credits to families and individuals, mechanisms to ensure that no one has to pay more than they can afford, etc.?
That may be true, but it’s only a problem if you object to government action per se, as opposed to government action of particular sorts.
No. See above.Report
John what would you have someone who can’t get health care and is suffering for it do? What would you, John Schwenkler, say to a person who is standing before you, asking you, “what should I do?”
There is a moral challenge in the face of another, John. That is a notion not only And I can’t begin to tell you how cruel you appear, when you meet every question about suffering with such derision. So what would you say, if you could actually put aside for one moment your incredible sensitivity and defensiveness on this issue, and tell me what you would have sick and suffering people do?Report
*not only found in the liberal tradition but in Christianity.Report
I’m not sure what you’re asking, Freddie, since as things stand there’s often not much that a person in such a situation actually can do. But as I’ve said many times, I fully support measures to make health care less expensive and provide the social safety nets necessary to ensure that all Americans can afford the medical services they need.Report