The State of “Reform”

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Mark of New Jersey

Mark is a Founding Editor of The League of Ordinary Gentlemen, the predecessor of Ordinary Times.

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7 Responses

  1. Avatar Freddie
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    says:

    I question the utility of this post.Report

  2. Avatar greginak
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    says:

    So advocates of public choice theory predicted that the growth of the filibuster requires supermajorities just to bring something to a vote ? It would not be hard to get 51 senate D’s to put together a far better bill with less of the things people seem to dislike.

    Stopping insurance companies from dumping people with preexisting conditions will be bad? Ending rescission will be bad?Report

  3. Avatar Bo
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    says:

    Is IOZ unaware of why this bill costs $900 billion (or $1.8 trillion if you follow Reason)? It’s because it’s spending a ton of money to subsidize poor people buying insurance. Yes, if all the bill did was mandate insurance, that would be ridiculously unfair to poor people, but this is just ridiculous nitpicking from someone who is mentally incapable of considering how two of the bill’s provisions might interact.Report

  4. Nob Akimoto Nob Akimoto
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    says:

    If you’re working from the premise that IOZ is in any fashion accurately summarizing the state of health care reform, fine, but the reality is a bit more complicated. There’s a lot more in the bill rather than just the mandate.Report

  5. Avatar trizzlor
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    says:

    In this case, the veracity of the article can be quite well gaged by the commentary:

    If McCain had been elected, he would have proposed exactly this Romneycare plan, and to play the game properly, the Dims would have had to shove in a puny Medicare “buy in” and a miniscule public option.

    Yes, that’s exactly what would’ve happened.Report

  6. Avatar Jaybird
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    says:

    Well, here’s that essay I finally got around to writing.

    My take on the whole health care bill thing.

    I’m against it but when I say that, people tend to respond as if I oppose the idea of people getting health care. This strikes me as similar to saying that people who oppose the Patriot Act support terrorist attacks on US soil.

    It’s no such thing, of course.

    I just don’t think that the law will do what the people who support the law want it to do. I actually think that the law will make things worse, not just in the short run but in the long run.

    But let’s break this down.

    We can go back to high school economics for the first part: price is a function of supply and demand. If the demand is growing at a rate greater than the rate of growth in supply? Your price will go up. If your supply is growing at a rate greater than the rate of growth in demand? Your price will go down.

    Fairly straightforward and uncontroversial, I hope.

    So let’s look at what makes up supply and demand.

    Demand is easy, so let’s look at that first. It’s when you need health care. Everything from the kid needing a measles shot to kidney dialysis to an MRI to diagnose why “it hurts when I do this”.

    So what is supply? It seems to me that it consists of two things:

    1) The time of the practitioners
    2) The tools they use (tongue depressors, MRI machines, prescription drugs)

    This describes everything in pre-natal care, natal care, child care, adolescent care, adult care, elder care, everything up to (but not including!) funeral arrangements. It can include the chiropractor’s time, the therapist’s time, the nutritionist’s time, the personal trainer’s time, supplies from the vitamin store, and even supplies from the local dispensary. All of these range from the “preventative” to the “reactive” and cover everything from physical to mental health (and the overlap between). (I am sure that I left out plenty of stuff as well.)

    So what is going on in the US?

    Well, the price is going up.

    What this tells me is that the rate of demand is increasing at a rate greater than the rate of supply is increasing.

    Which brings us back to this bill.

    This bill, as far as I can tell, is guaranteeing coverage to millions of uninsured people… but, as far as I can tell, it’s doing nothing to actually *INCREASE* supply. It’s guaranteeing coverage to people who need health care, sure… but if the supply is not increasing, this means that the bill will actually increase *DEMAND* instead.

    And if the supply isn’t increasing much but demand is increasing? By the fairly straightforward and uncontroversial definitions we looked at earlier, this will result in the price increasing.

    This will make things worse.

    Now maybe some people will be better off in the short run because the supply will be redistributed in new ways… but that short run is likely to be very short indeed when “the rich” and “the middle class” both discover that their own situations haven’t improved (but are likely to have gotten worse) despite paying more.

    “So what do you think we should do? PEOPLE ARE DYING!!!”, I hear you point out. “At least the people who are making things worse are doing *SOMETHING*.”

    Well, my solutions are, I hope, fairly straightforward and uncontroversial.

    We need more supply.

    That is, we need more minutes of time from the practitioners and we need more widgets for them to use/distribute. Widgets aren’t much of an issue, I wouldn’t think. We have more MRI machines per capita than Canada or the UK, for example. I’d be confident to say that we have as many (or more) scalpels per capita, dialysis machines, and other tech kinda stuff… which leaves me to wonder about stuff like available minutes of practitioners. The available minutes of any given practitioners are pretty much identical to the available minutes of you or me or anybody. 1440 minutes per day.

    If we need more minutes, then, we need more doctors (and nurses and anesthesiologists and chiropractors and therapists and pharmacists and candystripers and all of those).

    What’s the best way to get more of those?

    Well, there are a handful of ways, I’d reckon. The first is the “Northern Exposure” technique. Go to medical school and pass the equivalent of the bar exam and then spend five (or was it six? I don’t know how to count that last year) seasons in Cicely, Alaska. After your time is up, your med school bills are paid. Just have the government print out some money and pay those med school bills off. After putting your time in for half a decade (or whatever) in some remote place, any given doctor will have experience enough to move to somewhere else (maybe become a specialist) *OR* will have put down roots in a nice little local community and will become a nice little local doctor with established roots in the community.

    Additionally, do what is necessary to change residency as it is practiced. 90-hour weeks are not good ways to dispense health care. Those of you who write code, compare the code you write when you have a good night’s rest to the code you write when you’re strung out on nicotine, caffeine, and the McDonald’s value menu. Now imagine that you’re someone who will be setting a bone or dealing with someone who has lupus symptoms. (Yes, I know that some coder is going to say “I write better code when I’ve been popping!” I suspect that that probably isn’t as accurate as you remember… but I’ll ask who would you prefer to give you stitches? The guy who got 7.5 hours of sleep last night or the guy who is on hour 68 of his week who just drank his 7th diet coke of the day?) I suspect that residency burns out folks who would make good doctors or surgeons but who realize that they could probably make money that they’d enjoy just as much by working as an adjuster for an insurance company and have time to do something that isn’t work every now and again.

    Allowing the existence of little medical shops that would be the equivalent of Perfect Teeth (from the Perfect Teeth website: “In fact, the majority of our dentists owned their own practices prior to joining our group. They wanted to continue to practice dentistry without the responsibility of the daily business and administrative duties.”) to provide something akin to a “chain” doctor office.

    The fundamental question that I’d be asking for any given policy put forward would be this: “Would this make it easier to become a doctor/nurse?” If the answer is “yes”, then that’s something that would likely increase the supply of practitioners’ minutes. If the answer is “no, not really”, then that’s something that would likely *DECREASE* the supply of practitioners’ minutes. If the answer is “it wouldn’t change things one way or the other”, the question would then become “will this decrease demand for medical care?” If the answer is “no, it won’t change things one way or the other”, then how is what you are doing helping at all? If the answer is “it will increase demand”, then the policy is likely to make things worse. (And, to be honest, when it comes to stuff that decreases demand for health care, the stuff that comes to mind is stuff like “emmigration” or “death”.)

    I can appreciate the arguments that children are dying and people deserve health care and whathaveyou… but I look at the bill going around Washington right now and I haven’t read it (not even all of the Representatives and Senators have read it… I suspect that the insurance companies that wrote it are the only ones who have read it) but I’m guessing that there isn’t a whole lot of things in there that make it easier to become a doctor or nurse or otherwise increase the supply of health care to divvy out. Instead, it’s promising more health care to more people (increasing demand) and will, because of that, make things worse.

    So we’ll have a president waving a piece of paper to thunderous applause promising “Health Care In Our Time!” when, in reality, he’s just this guy yelling something while waving a piece of paper.

    If, in a couple of years, you’re wondering why things haven’t gotten better? This is why. It became more troublesome to be a health care practitioner than less troublesome. More people needed more health care than they did a few years before. The demand increased. The supply decreased.

    The price is going to go up.Report

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