Townhall.com George Will October 19, 2006
Recently Bill Clinton, at the British Labour Party’s annual conference, delivered what the Times of London described as a “relaxed, almost rambling” and “easy anecdotal” speech to an enthralled audience of leftists eager for evidence of American disappointments. Never a connoisseur of understatement, Clinton said America is “now outsourcing college-education jobs to India.”
But Clinton-as-Cassandra should not persuade college students to abandon their quest for diplomas: The unemployment rate among college graduates is 2 percent.
Clinton is always a leading indicator of “progressive” fashions in rhetoric. And every election year — meaning every other year — brings an epidemic of dubious economic analysis, as members of the party out of power discern lead linings on silver clouds.
“Worst economy since Herbert Hoover,” said John Kerry in 2004, while that year’s growth (3.9 percent) was adding to America’s GDP the equivalent of the GDP of Taiwan (the 19th-largest economy). Nancy Pelosi vows that if Democrats capture Congress they will “jump-start our economy.” A “jump-start ” is administered to a stalled vehicle. But since the Bush tax cuts went into effect in 2003, the economy’s growth rate (3.5 percent) has been better than the average for the 1980s (3.1) and 1990s (3.3). Today’s unemployment rate (4.6 percent) is lower than the average for the 1990s (5.8) — lower, in fact, than the average for the last 40 years (6.0). Some stall.
Economic hypochondria, a derangement associated with affluence, is a byproduct of the welfare state: An entitlement mentality gives Americans a low pain threshold — witness their recurring hysterias about nominal rather than real gasoline prices — and a sense of being entitled to economic dynamism without the frictions and “creative destruction” that must accompany dynamism. Economic hypochondria is also bred by news media that consider the phrase “good news” an oxymoron, even as the U.S. economy, which has performed better than any other major industrial economy since 2001, drives the Dow to record highs.
. . . more
This article totally ignores the fact that while the economy has been growing most in the middle-class have not felt the benefits of that recovery.
Health care, wages, energy costs put squeeze on middle class
The Center on Budget and Policy Priorities provides these telling statistics:
IN FIRST HALF OF 2006, WAGES AND SALARIES CAPTURED SMALLEST SHARE OF INCOME ON RECORD
Note 2, Dean, can’t support open immigration then complain about stagnant wages
Let’s assume for the sake of discussion that you have a valid point concerning stagnant wages. You can’t support open immigration, as you do, and then complain about stagnant wages. Twelve million people willing to work below minimum wage, willing to work “off the books” and willing to work without regard of government mandated safety regulations depress wages for the remaining population. However, it is the least skilled that are hurt the most. The hypocrisy of the open immigration crowd and their insufferable moral posturing is unmatched in today’s politics. Their policies hurt the least skilled workers the most, but, that doesn’t matter, the “open immigraiton” crowd wants the votes OR it wants to be able to run factories and farms free of economic regulation like safety and minimum wage and withholding tax.
The next point is somewhat subtle but important. There is a trade-off between wages and employment. Lower wages promote greater employment, employers are more willing to hire if they have to pay less. It is not clear that the economy is necessarily better off if wages per se are higher because people live in households of multiple wage earners. It may be better for a household to have more adult and able bodied people employed at a lower wages than have fewer people employed at a higher wage. Also lower wages help younger and less skilled workers get a “toe in the door.” As I have explained many times, my company hires college age youngsters as interns over the summer at a very modest wage. However, it is win-win because we give them invaluable training at the same time that they get paid to work. Many have gone on to terrific careers based on what we taught them. The knowledge we share cannot be acquired anywhere else, not even in academia. Push wages up and this will stop. American unions have always worked for higher wages for their members fully knowing that fewer people will be employed as a result. It is an inevitable as the swallows returning to Capistrano.
Clinton economy/Bush economy: Back in 1986 TIME magazine did a special cover story on Clinton economy giving glowing praise to Larry Summer and Robert Rubin. Fair enough the economy was doing well and I actually have great respect for both Rubin and Summer. Today’s economy is at least as good and the press has no time for it. When an administration’s macro-economic policies produce low unemployment, a growing GNP and very modest inflation, that is terrific. Period. These are the goals of macro-economics, growth, employment and low inflation. The economy is great, business people are optimistic and they are HIRING.
Again, remember the essential contrast between liberals and conservatives. Liberals want to “solve” poverty by handing out money to “the poor.” Conservatives want to “solve” poverty by getting “the poor” jobs. Big difference. The conservative option does not create bureaucratic jobs for middle and upper class liberals, the true goal of all liberalism, government by bureaucrat. Never shall the twain meet.
Push wages up artificially and fewer workers can “win” jobs.
If an employer is required by law to pay a minimum wage, then those people who are less skilled will not get a job. Young people will not get a “toe in the door” to get started and earn job experience and real work skills. People with a lower level of education will not be able to competwe and jobs will go to those who are better educated. Some jobs will disappear altogether as employers replace people with machines. Even grocery store checkers have been replaced by machines, the trend has started that that job will eventually disappear. You can thank the anti-Walmart crowd for that push towards technological efficiency.
In my field, the classic ratio of secretary to lawyer was something like 3 secretaries to 2 lawyers in the days of the typewriter. One of those secretaries would have high level English composition skills, one would have moderate skills in document production and the third would have modest skills but would do scheduling, xeroxing and courier work. Now the ratio of secretary to lawyer is 3 lawyers to 2 secretaries. The secretarial jobs are disappearing because lawyers use sophisticated work processing tools that have eliminated much secretarial work. Only the most skilled secretaries have kept their jobs and the pressure is on them to be more and more productive doing more and more sophisticated, intellectual work.
Try explaining this to a liberal, even demonstrating it with historical data and he is still stuck with the “it is immoral to pay less than a living wage.” Right.
Then you agree that we don’t have a great economy – that is if you define a great economy as a rising tide that lifts all boats. The middle class is in an economic squeeze but not because of the right-wing hob-goblins you cite, minimum wage and illegal immigration.
The causes of economic pressure on the middle class are stagnant wages combined with higher health insurance and fuel costs. Middle-class anxiety has been heightened by changes that shift greater risk, such as the costs of health care and retirement, away from employers and on to individuals.
There are no empirical studies that support the contention that modest increases in the minimum wage depress jobs, however there are many that indicate that increasing the minimum wage boosts the economy. For example,
Study: Minimum-wage law hasn’t hurt job growth
Minimum Wages and Employment: A Case Study of the Fast-Food Industry in New Jersey and Pennsylvania
New Findings from Oregon Suggest Minimum Wage Increases Can Boost Wages for Welfare Recipients Moving to Work
.
Increasing Missouri’s minimum wage
Note 5, Dean, no I disagree
Dean, you are fighting a losing battle. The tradition in American politics is that people look to Washington to formulate policies which minimize unemployment, minimize inflation and promote at least moderate growth. Bush’s policies have done that and he is entitled to credit. Comparable economic achievement by the Clinton adminstration was given a cover story at TIME magazine.
Since the macro numbers are so good, you have to dig to attempt to find something negative. I didn’t concede anything in my last post.
I have seen that average household net worth is up and that is most decidedly a good thing.
Health costs are not the responsibility of employers. Moses did not bring a stone down from Mount Sinai containing the phrase “Employers shall adopt each employee and provide health insurance.” Prior to 1950 virtually no employers provided anything towards the cost of health insurance. After WWII there were still wage and price controls and employers threw in health insurance coverage as a way to attract good workers and avoid the limits placed on wages.
If my husband and I were allowed to take back everything we have paid into Social Security or the Medicare system, we could very easily fund our retirement and our health insurance. We could invest those funds far, far better than the government will. In fact, everything that I have paid in over the years has gone directly to someone else to spend that very year, it has not been invested for me to drawn on when I retire. I have no guarantee that I will receive even a 2% rate of return on what I have paid them.
Let me have my Social Security and Medicare money back and I will not need anyone’s help to take care of myself.
If you counter that I should be willing to pay for those too poor to pay for their own retirement or health care, I would point out to you that Social Security is an entitlement that does not take income or wealth into account. Social Security is not welfare and it does not have an income test for the recipients. Plenty of wealthy people collect social security.
Just give me my money back and I will take care of myself and contribute to the charitable organizations that meet my standards. We would save ourselves the astronomical cost of all those bureaucrats.
Missourian writes: “I have seen that average household net worth is up and that is most decidedly a good thing.”
The average doesn’t mean much. Look at the median:
http://www.washingtonpost.com/wp-dyn/content/article/2006/02/23/AR2006022300799.html
So people are more productive, but being paid less. Well, I guess someone has to pay for those golden parachutes.
Missourian: “Health costs are not the responsibility of employers. Moses did not bring a stone down from Mount Sinai containing the phrase ‘Employers shall adopt each employee and provide health insurance.’”
Don’t worry, if the stone tablets had said that, the right-wing would find a way to interpret that away — “that was in the time of Moses, Jesus set us free from the law,” etc. When it comes to economic issues, the Bible has never been barrier to the right.
More to the point, for better or worse, employer-provided health insurance has become part of the tradition of work in the U.S. If you don’t want government-provided health insurance, and you don’t want employer-provided health insurance, then that means that the individual worker has to pay for his or her own insurance. That actually works out fine, as long as the individual has income sufficient to pay for all that. For many families that would be over $10,000 per year. Of course, with individuals paying for their own insurance, each familiy would be their own risk pool, thus making the cost significantly greater. On top of that would be any additional co-payments, or payments as a percent of charges. That could add a few thousand dollars more per year, and even more depending on whether the insurance had any out-of-pocket limits.
Without a system of employer-provided health insurance, most families would do what some families do now: go without and hope for the best. In the event something bad happened, the family would simply lose everything, or just do without health care. Of course, for many of the current “followers” of Jesus and their dog-eat-dog, every-man-for-himself theology, that’s an acceptable outcome.
Jim Holman confronts the unthinkable: financial self-sufficiency
Jim. I know that the concept of individual, financial self-sufficiency causes you to shudder but a great deal can be done IF people are freed from the very regressive Social Security tax. At best, the rate of return is 2% with absolutely no guarantee that the benefits will be there even after decades of contributions. Social Security amounts to 15% of everyone’s paycheck, every week, every month, every year of their working lives. If people were simply be given that money back most people could be self-sufficient when it came to health-care. Simpler devices such as tax-sheltered health savings accounts could be used. Here I have just focused on the Social Security tax, it is just the beginning.
However, these carry with them the fatal flaw: no federal and state bureaucrats to administer the program. Bureaucrats are the Brahmins of the Left. The bureaucrats must increase in number and power and financial security. Their pensions and health care benefits must be many times the value of those of the mere “worker bees” who produce real wealth.
We have a great economy, Jim, deal with it, as painful as it is to you, I know.
Note the “economist” quoted works for a “think-tank” that focuses on “labor issues. TRANSLATION: This “think-tank” is funded by labor unions and its experts are trotted out to find the “lead-lining” in every piece of good news.
“The causes of economic pressure on the middle class are stagnant wages combined with higher health insurance and fuel costs. ”
Dean, for someone who likes to cite “empirical” evidence, I find the above statement funny coming from you. Unless you define “middle class” to include the lower class (something I find common among liberals) the above is patently false by every measure. The lower class is paying the price for not staying in school, and sometimes for staying in failing schools that liberals run. The market is demanding more and better skills (education), and thus lower paying jobs are harder and harder to live off of. I suggest you start a “poor house” or some other program at your church. Advocating massive government programs (welfare, minimum wage hikes, etc.) does not even gather votes among liberals anymore…
Over the past ten years the percentage of employers offering health insurance has dropped from 69% to 60%. Double-digit annual health care inflation means that health benefits are increasingly unsupportable for many employers, and a growing drag on our economy.
A foreign auto maker opening a new plant has an instant advatage over older American automakers, like Ford and GM – it is not burdened by expensive retiree health costs. However, the foreign auto maker may even look at the cost of providing health care benefits to new employees in the US and decide that Canada, where there are no employer health care costs because of National Health Care, is the more economically favorable location.
Ultimately, we will have to introduce some form of National Health Care in the United States, for this simple reason: We are not going to be able to fix the federal budget deficit until we rein in the cost of Medicare, our government’s largest long-tem unfunded liability. We are not going to be able to rein in the cost of Medicare until we are able to slow down double-digit annual inflation in health care. Finally, we will not be slow down double-digit annual inflation in health care without some form of National Health Care .
The current approach is to shift more costs to the individual. Without slowing the annual rate of inflation in health care, however fewer and fewer individuals will be able to afford coverage. Medicare and Medicaid will struggle with rapidly increasing enrollment. Hospitals will be forced into bankruptcy by the costs of providing unreimbursed care to the uninsured. Untreated illness will impact worker productivity. Infant mortality rates will increase and age lngevity will decrease. Ultimately our entire system of Public Health in the United States will collapse.
Note 9. Dean writes:
Could someone explain the logic here? A large portion of the federal deficit is an underfunded Medicare system. To way to solve this deficit problem is to shift health care to the public sector. But how is this going to do anything except increase government spending (not to mention an inevitable decline of service)?
This just seems more of the old Democratic (and Republican these days) creed of spending your way out of debt.
Note 9, Dean, the national health care systems of Canada and Europe are failures
As always, Dean supports handing a problem to government for solution. We have a massive problem with Social Security. Social Security has been mishandled by government and government has created a bigger problem than Social Security was enacted to solve. Now, Dean, oblivious to facts, as always wants to give a government that has failed with Social Security another huge task; national health care.
He is oblivious to the total failure of the NHS in the UK and in Canada. Read about the NHS in Britain and you will see that its budget has grown by leaps and bounds every year for decades, edeeply in the red. Britons are beginning to argue for its dismantlement. So, of course, Dean rushes in and states that we should have the same.
Everything for more government, all the time for everything. Dean will make us serfs of the bureaucracy his friends will run.
Medical apartheid as English cancer patients are denied life-extending drug
http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=411521&in_page_id=1770
Obviously these people are ungrateful to their omniscient, all-caring government, they can’t appreciate a panacea when they have one. Doubleplusungood!!!
Note 10,
Dean is right, but of course we know the cure is worse than the disease. However, I think there will be some form of “universal coverage” implemented by the Fed’s in the next 15 to 20 years, simply because the liberals will be able to convince a majority of Americans that the cure is better than the disease. It will be at this point that the medical system will slow significantly in advances and our standard of health care will actually drop – which means our standard of living will drop. By the way, this huge expansion of government will be led by Republicans, because the Dem’s don’t have the clout. The Republicans are now the “liberal” party, with the Dem’s being the uber-euro socialists. I will not be voting Republican this year, and maybe not again ever. I wait for a third party or some other real conservative choice.
With my wife completing her residency in a bit over a year, we have been discussing what this coming catastrophe means and how she can best position herself as a future government worker. Even more importantly, we have been discussing how we can attain good health care for our family. On option will be Mexico, where many US doctors will be able to practice medicine outside the coming government rationing system. I would recommend everyone start thinking about it now, and perhaps plan financially on how you will get around the coming “universal access to a waiting list” that liberals foolishly think is a good thing…
Father: National Health Care will reduce the projected cost of Medicare by slowing the rate of medical inflation. National Health Care can slow the rate of medical inflation by doing the following:
1) Eliminating much of the adminstrative redundancy that currently exists in private health care. Administrative costs comprise about 5% of all Medicare expenditures, but 15% of private health insurance expenditures. I recently read an article in Health Affairs magazine that found that 20-22% of every dollar paid to California hospitals was consumed by billing and insurance related activities.
2) National Health Care can use the purchasing leverage of the entire nation to negotiate lower prices for drugs and medical equipment.
3) National Health Care can help fund investment in IT and other medical technology that produce reductions in health care costs over a long-term time period. The VA system has already had a lot of success in this area. Private medical entities have a more difficult time developing a business case for these investments.
4) National Health Care can do a better job of encouraging and providing preventative care. This way, instead of spending a lot of money treating people after they become sick, we would spend less money to keep them healthy before-hand. Currently, it’s more profitable for providers to treat the expensive results of acute illness, than it is to provide lower cost preventative care.
5) National Health Care would lower hospital costs by eliminating the expense hospitals face of providing unreimbursed care to the uninsured – a cost passed on to those with insurance.
The simple fact is that we spend twice as much, per person, on Health Care than Western Europe, but have health indicators and outcomes that are no better, while leaving 16% of our population uninsured. That alone should tell us that the US health care system is in trouble and needs to revamped.
What a wonderful thing it must be to be able to dispose of social programs that work, replacing them with programs that in many cases have already been found wanting.
“Worker Bee” writes: “If people were simply be given that money back most people could be self-sufficient when it came to health-care. Simpler devices such as tax-sheltered health savings accounts could be used.”
Health Savings Accounts are the sweetner that is supposed to help people swallow the bitter pill of high-deductible health plans. The idea is that you pay a large amount out of pocket before the health plan pays anything, and then when the health plan does pay, a huge amount of risk is shifted to the employee.
Yes, where I work we have a high-deductible health plan and HSAs, but I have insurance from my wife. When these were implemented, we had a large number of people leave. They voted with their feet, in other words. But not everyone can leave. One of my co-workers stopped buying her asthma medicine because she could no longer afford it. Another stopped purchasing the pain medicine that she uses to control the pain from a crippled knee. Can’t afford it.
High-deductible health plans have been criticized in publications as diverse as Consumer Reports and the Journal of the American Medical Association. It’s like living on a flood plain — it’s a great idea until bad weather comes.
HSAs are fine for the occasional doctor visit or cheap generic prescription. Beyond that, even a single modest surgical procedure would wipe out the account. For example, a knee arthroscopy is a common, simiple procedure done under anesthesia that takes 30 or 40 minutes. Total charges from start to finish — diagnostics through followup — can run close to $15,000. Say goodbye to your HSA balance. And if you have any kind of chronic health problem requiring more than minimal health services — forget about it. Even if you eliminate the Medicare tax, you’re not going to get anywhere near that kind of money.
“Worker Bee”: “However, these carry with them the fatal flaw: no federal and state bureaucrats to administer the program. Bureaucrats are the Brahmins of the Left. The bureaucrats must increase in number and power and financial security.”
Actually, if you put down the libertarian bong and enter back into the real world for a moment, you find that administrative cost of Social Security are very reasonable, compared to other options. SS administrative cost soak up about 2 percent of assets. Other plans would have administrative costs anywhere from 5 to 30 percent of plan assets. These figures are from the Congressional Budget Office: http://www.cbo.gov/showdoc.cfm?index=5277&sequence=1
Fr. Hans writes: “Could someone explain the logic here? A large portion of the federal deficit is an underfunded Medicare system. To way to solve this deficit problem is to shift health care to the public sector. But how is this going to do anything except increase government spending (not to mention an inevitable decline of service)?”
Actually, right now Medicare and SS are running surpluses. President Shrub is borrowing from those surpluses in order to fund democracy in Iraq and tax reductions for the well-off. So that money will have to be repaid some day. But the point is that those programs are not currently adding to the deficit.
I think what you’re talking about is Medicare’s long-term unfunded liability. That means eventually the program starts to run a deficit. An unfunded liability is not a good thing, but it’s not a tragedy either.
For example, the day you had your first child you created an unfunded liability of a couple hundred thousand dollars for food, orthodontia, college eduction, and so on. What most people would do is to juggle money around, work some evenings and weekends, cut back in other areas, and so on, thus paying for the cost of the child. The new Republican view would be to look at the unfunded liability with fear and trembling, and then “cancel the program” by giving the kid to an orphanage.
There are several advantages of having a system of basic public health coverage.
First, potentially everyone would be covered.
Second, there is a potential for a great reduction of overhead administrative costs. Currently, hospitals and physician practices have to deal with literally thousands of different health plans. I don’t have any definite numbers, but I would guess that around the country there are hundreds of thousands of people, perhaps even a million or more, who do nothing but process health insurance claims. From the point of view of healthcare, this is a completely non-value-added overhead activity.
Third, a single health plan would have a tremendous ability to leverage its purchasing power to get significant discounts on pharmaceuticals, medical supplies, durable medical equipment, and so on.
Fourth, a national plan would take health insurance off the backs of employers. This would make U.S. firms more competitive in the international arena. It would also make it easier for people to get jobs. Since health insurance wouldn’t be a factor in employment, you would be able to take a job without worrying about whether it came with health insurance.
I”m not saying that there wouldn’t be problems with such a system. Every system has problems. I’m just saying that there’s no need to wallow in this ridiculous libertarian fantasy that everything public has to be work that everything private.
Note 14,
Yes, and if we can just get all these workers to unite…I kid, I kid. Seriously though, have you read anything lately about this easy comparison between us, the uber-socialists in europe, or even the Canadians? Have you read Missourian lately? “outcomes” no better? How can you say that, unless you think simply dieing is better? Oh wait, I forgot, this is blog is high school debate and the veracity of your claims are secondary to how many citations you can cram in your 2 minutes…
Note 14. Dean writes:
Not too sure about your “fact” that we spend twice as much per person on health care than Western Europe (maybe their care is only half as good) but let’s run with it for the time being. Also, the 16% uninsured is also questionable given that it contains the young (who often reject insurance because they don’t need it); illegal immigrants, etc. but we will let that stand too.
But what ever makes you think that the European or Canadian health care systems are worthy of emulation? Are you aware that the rich in England are going to India and other places to get operations done that they would otherwise wait two years to receive?* Canadians now come to America for their health care because much of it can’t be delivered on time in Canada. (Non-delivery might be one reason why the spending is lower.)
*How do Progressives respond to this unfairness? — especially the wealthy ones?
The medical system needs some tuning, no doubt about it, but your unbounded optimisim in a statist solution is naive given the historical record of the countries you hold up as examples.
I had to go to a hospital in Greece (yup, government health care) for some blood tests to get a visa when I lived there. It wasn’t quite third world, but it sure seemed close. If it was America they would close the hospital down.
Sorry Dean, but liberals wrecked the schools in the inner cities. We don’t want their hands on our medical care.
Note 15. Jim writes:
This is a technical issue. Currently no standardized system exists. One needs to be created but nationalizing health care is not necessary in order to create it. Even if health care was nationalized, the cost for creating such a system would still be the same as under our current system (proprietary database systems are the same regardless). And, once developed, the same savings are realized either way.*
So, let’s fix it.
Would it? Or would it convert the pharmaceutical and related industries into a kind of public utility, much like the electric company? This would work for a while, but eventually the R&D would dry up, a lot like the decline of the electric infrastructure, and the advancements would be a lot slower in coming.
Again, look at Europe. Most medical advancement (pharmaceuticals, equipment, etc.) comes from America. Europe and Canada have lower drug prices only because they price control American drugs thereby shifting all the cost of R&D to the American consumer. A small part of every prescription you pay for subsidizes these European and Canadian controls.
Would it? Or would employers pay for it through higher taxes once the government takes charge of health care? This is at best a wash, but more likely the costs would increase given the government’s natural inefficiences in administering complex programs.
All national health care does is change the cost structure. Most likely business will feel the greatest impact since politics will require the maintenance of the illusion that the taxpayers are receiving health for “free.” Of course, tax rates will also rise (stealth taxation) for the consumer as the inefficiences increase over time (an inevitable development). All told, the plan to nationalize health care can only end up costing at least as much as it costs today at first, then increasing above what private care would be after a decade or two, thereby resulting in a decrease of service as a way to contain costs. This is the cycle of Europe and Canada. No need to repeat their mistakes in the US.
Finally, given the serious ethical issues debated today, do we really want government bureaucrats appointed by the likes of Hillary Clinton (whose relentless promotion of abortion in non-abortion third world countries serves as a national disgrace), Barbara Boxer, and others, deciding who gets to decide the life and death issues? The debates today are messy enough, but can imagine the threat to the unborn, infirm, and aged if they gain this kind of authority and power over the medical profession? Ideology has always driven their policies on life and death in the past and it will here as well.
*Of course, if the IRS is any indication of government finesse with computer systems (millions of dollars spent over ten years and still no uniform data base retrieval; in fact, their system to cure their old system was recently scrapped as unworkable), I’d prefer a private sector solution. (Can you imagine this ineptitude applied to serious health issues?) Looks like the FBI had its share of problems too.
Note 13. Christopher writes:
Actually, this is not at all far-fetched. Government control means a decrease in quality and service. Doctors will set up shop outside of the reach government regulators and those able to afford the care will use it — just like the Canadians coming to America, or the Brits flying to India. The draw will be better and more timely service.
Why we should trust liberals with health care when we see their record with education is beyond me.
Fr. Hans: “This is a technical issue. Currently no standardized system exists. One needs to be created but nationalizing health care is not necessary in order to create it.”
There is a standardized system of billing. There is the UB-10 (Universal Billing standard computerized medical claim form). There is the system of DRGs (diagnosis-related groups) used by Medicare and other insurers. There are the ICD codes (standardized diagnosis and procedure codes). There are various other standard forms and systems of codes. All this is currently in place. By the way, Medicare pioneered the system of DRGs, which allows inpatient incidents of care to having standard payment rates, thus encouraging shorter lengths of stay and thus less-expensive care.
The problem is that there are literally probably hundreds of thousands of different health plans and thousands of insurers. And there who who knows how many hundreds of thousands of people involved in processing these claims. And that’s on top of the thousands of different formularies and approval groups throughout all the insurers. So there’s a huge opportunity for taking advantage of economies of scale.
Fr. Hans: “Or would it [leverage of purchasing power] convert the pharmaceutical and related industries into a kind of public utility, much like the electric company?”
Well, look at what Wal-Mart has just done. They are able to offer almost 400 generic drugs for $4 for a month’s supply. And I don’t think they would offer something like that as a “loss leader,” either, though obviously they hope to attract other business. How do they deals like that? Through bulk purchases, contracts, and a superior logistics system. All of these things drive excess cost from the system.
Fr. Hans: “All told, the plan to nationalize health care can only end up costing at least as much as it costs today at first, then increasing above what private care would be after a decade or two, thereby resulting in a decrease of service as a way to contain costs.”
It doesn’t have to be that way at all. I don’t believe that a single-payor or few-payor system would have to be run by the feds at every level. You’ll still have plenty of private enterprise. What you will also have is potentially a great reduction in non-value-added overhead costs and duplication of services. In the examples I mentioned both the public and private sectors have played a role in reducing cost.
Fr. Hans: “Finally, given the serious ethical issues debated today, do we really want government bureaucrats . . . deciding who gets to decide the life and death issues?”
But you already have that with Medicare and Medicaid. To the extent the government is involved, at least you have some control through elections. Look, someone is always going to be making decisions. If it’s not a government bureaucrat, then it’s a corporate officer. There’s not a private health plan in the country that doesn’t have significant control over the health services that their clients receive.
Fr. Hans: “Of course, if the IRS is any indication of government finesse with computer systems (millions of dollars spent over ten years and still no uniform data base retrieval; in fact, their system to cure their old system was recently scrapped as unworkable), I’d prefer a private sector solution.”
How about the best of both worlds? Where I live Blue Cross administers Medicare reimbursement. When you get audited by Medicare, Blue Cross people do the audit. Again, government can play a crucial role in establishing a uniform system, even as the private sector actually runs large parts of the program.
Dear worker-Bee and Mr. Dean Scourtes:
How many of you are actually in the health care delivery system of the US?
I started assisting in autopsies as a teenager in Houston, Texas, naval Medical and Dental Corps in the 40s, premed in the 50s and in the pharmaceuticals for more that 20 years. I have even spoke at Ground Rounds in the U. of Colorado and Arizona medical schools. I have written package inserts approved by the FDA and set up independent product studies.
In the service there was general medical delivery to everyone but ‘more so’ for the officers. In the pharmaceutical business-I helped introduce Librium and Valium, etc- the motives were new drugs to care for patient health but the patient as a profit center was always present. The patient as a profit center is now seemly the formost concept in the US. The goverment has yielded almost all profit control to the provider. The patient is an after-thought, like in communisum- a source of capital. Read the full texts of that movenment.
I have lived in Germany for 15+ years, studied the health care delievery system while in Sweden and experienced the French delievery system with my eldery realtives in France; the US system spends much more money per unit of delievery than in what you call the ‘socialist systems’. The base of their system is preventive medicne. They are in reevaluation at present-not broke.
Medical delievery systems are in a constant state of flux, the administrative and governmetal organizations must be in constant evaluation and reorganization.
There are 46+ medically uninsured in the US; if bird flue strikes in that area, than the above is acidemic. The rich die as easly as the poor.
Sincerely yours, J R Dittbrenner
J. R. Dittbrenner writes: “I have lived in Germany for 15+ years, studied the health care delievery system while in Sweden and experienced the French delievery system with my eldery realtives in France; the US system spends much more money per unit of delievery than in what you call the ’socialist systems’. The base of their system is preventive medicne. They are in reevaluation at present-not broke.”
You are absolutely correct. The problem is that in the U.S., and certainly on this blog, many people are ideologically opposed to the idea that the public sector can do anything very well, and along with that is a kind of cult worship of the private sector. So for many people, anything largely supported by the public sector has to be bad, because their ideology insists on that.
Also, public healthcare is seen as a “liberal” idea, and therefore (so they think) it must be a bad idea. For example, Fr. Hans above notes that “Why we should trust liberals with health care when we see their record with education is beyond me.” Of course the one has nothing to do with the other. One could easily argue the same for conservatives. Why should we trust conservatives given their record in Iraq? Given that kind of analysis, I suppose we shouldn’t trust anyone to do anything.
Also Christopher, in note 13, erupts in an orgasm of apocalyptic nervousness. The evil liberals will ruin healthcare, and he’ll have to go to Mexico for health care!! Que le vaya bien, amigo, and don’t let the door hit you on the way out.
Anyway as you say, if you look at the outcomes and the costs, the U.S. system is inferior to many other systems that have more public funding. Compared to Canada, France, Germany, and other countries, the U.S. has lower life expectancy and higher infant mortality. In addition, we spend more than twice as much per capita on healthcare than these other countries. The last I heard, per capita healthcare spending in the U.S. was around $5,000; in Canada it is around $2,000.
Even though these other healthcare systems obviously outperform ours, those on the political right in the U.S. always look for problems with these other systems, and having found problems, trumpet those as “proof” that these other systems “don’t work,” or that they are “failing.” Meanwhile they ignore the obvious problems in the U.S. system. Well, every healthcare system has problems. For example, certain procedures in Canada have long wait times.
I suppose the Canadians could fix that if they decided to spend more on healthcare. But that doesn’t mean that the Canadian system is broken or failing.
But here’s one thing to remember: any time healthcare is discussed in this venue, it really isn’t a discussion about healthcare. It is really just an opportunity to bash “liberals” and “the left.” So you can present all the arguments and data that you want. You can present all sorts of new ideas. But none of that matters, because the real discussion is all about left-bashing, and healthcare is only the lubricant for that.
Note 21, JR Dittbrenner, fine, but let us first seriously study the flaws of the current systems and get Social Security in order
Dear JR:
First, the topic is very complex and I readily concede that reasonable people can differ. However, I think it is very important to study the shortcomings of the Canadian, UK and French systems. We cannot afford to ignore the volcanic discontent of a large percentage of the population in those countries. Let us at least study and learn before we repeat their mistakes.
Second, one fact stands starkly in front of us, that being, that the government or the political system has badly mismanaged Social Security. We do not have answers for that terrifically difficult problem. Adding a nationalized health system to the tasks of government at this junction is irresponsible until we have fixed Social Security.
Lastly, you may not have read the ongoing debates between Dean and I. Reasonable people should consider less draconian means of correcting our current situation than a national health system. Dean’s answer to nearly every issue is to hand the problem to government thereby increasing government’s power and influence over our lives. Reasonable people should be concerned that a national health service would arrogate to itself immense power over everyone’s lives. I, for one, do not want to be dependent on a national health service, thank you very much.
There are respected economists who have proposed alternatives to national health insurnace on the European model. Those alternatives include medical savings accounts and health-care consumer consortiums. For instance, it would be possible to allow a consortium of small businesses to band together for the purpose of negotiating health insurance premiums for its members and employees. This would simply increase the bargaining power of one sector of the market and cause insurance companies to compete for the business of the consortium.
Few people have seriously considered the idea of promotaing competition among health care providers. Competition does drive down costs. Ponder the following. One health care provider offered me a standard treatment for the price of $1600, another health care provider offered me the same treatment for $350. By the way, the health care provider which offered me the service at the price of $350 was a board-certified specialist M.D.
Thirdly, measuring the performance of a system is not simply or straitforward. One stuyd looked at a class of patients who suffered from breast cancer. They took large, representative samples of American breat cancer patients and Canadian breast cancer patients. American breast cancer patients did better: more recovered, more survived and more lived longer EVEN with the difficulties of the American system. SO COST is not the only criteria. Good patient outcome is more important.
This is a complex topic and I am not sure that anyone here has the expertise in the economics of health care that may be needed to fully appreciate the alternatives. All I can say regarding Dean is that government is Dean’s answer to everything. I don’t think we should simply hand government another critical task when it has failed to handle Social Security well, we have no assurance that what will occur will be a success.
Estimates of the uninsured in America: 1%,5%,10% or 15%?
I have seen estimates of the number of uninusred in America ranging from 16 million to 46 million.
Percentage of population: 16 million is 5% of the population, 46 million is 15% of the population. Standing alone these may be figures we can live with, given that the lack of insurance does not necessarily mean the lack of health care.
Uninsured does not equal untreated: I have been uninsured for a number of years of my life, the fact that I was uninsured did not block me from receiving medical care
Illegal aliens: Are we counting the 12 million illegals as “without medical insurance?” If so, the numbers of uninsured are far less destressing.
If medical providers compete, prices will go down and more people will afford health insurance. We need to find a way to allow people to compare prices for medical care and a way to allow people to shop around. It can be done.
Missourian writes: “If medical providers compete, prices will go down and more people will afford health insurance. We need to find a way to allow people to compare prices for medical care and a way to allow people to shop around. It can be done.”
They already compete. The payments to medical providers by insurance companies are set by contract; what the medical provider receives for a service typically has little or nothing to do with the charge that appears on the bill. If you want competition, it’s already there. The only people who have to pay full charges are — drum roll please — the uninsured, and no one is very interested in competing for them.
What has interested me about this discussion is that Fr. Hans always says that the “liberals” only have tired, old ideas, and that the conservatives have all the new and exciting ideas. So what have the conservatives offered in this discussion? Well, they want to eliminate all government-sponsored health care. Then you point out that employers shouldn’t have to offer health insurance. The conclusion is that people should pay for their own health care. They are supposed to do that with Health Savings Accounts.
But HSAs are only good for minor expenses — the occasional test, doctor visit, or prescription. When you talk about people with chronic health problems, or serious acute problems, HSA balances vanish faster snow on hot pavement. You could put $1,000 into an HSA every month for a year, and that money would be completely wiped out by a single simple day surgery procedure. When you get into serious procedures such as joint replacements or coronary bypasses, the HSA is basically pocket change. Get into the really serious problems such as kidney failure, dialysis, and transplants, and the HSA is washed away like a bamboo shack in a tsunami.
In short, having everyone pay for their own healthcare with HSAs would be a wonderful way to drive millions of people into bankruptcy. After those people have been wiped out by medical expenses, I’m not sure what is supposed to happen to them then. This seems to be the exciting new idea that the conservatives have. It’s only virtue is that it is consistent with the “every man for himself, dog-eat-dog” Christian libertarianism that is promoted in this venue.
The only thing I can conclude is that when the Christian libertarians read “blessed are the poor” in the gospel, they understand that as a command to not to help the poor, but to create more of them.
Note 25. Jim writes:
Essentially yes. Liberals seem unable to evaluate their ideas based on results. The hard left in particular, and the Progressives absolutely, consistently confuse intentions with results which has led to paralyzing social problems such as institutionalized poverty, the denegration of public education (particularly in Democratic controlled inner cities), the collapse of the black family, and more.
Thankfully some of these problems are being addressed (welfare reform for example) although unquestionably the thinking on these problems comes almost exclusively from conservative quarters. The Manhatten Institute for example provided the theoretical framework for the Gulianni turnaround in New York. (I lived in New York under Dinkins, and later under Gulianni. It was like night and day.)
Health care reform is a very complex problem and finding solutions will not be easy. What won’t work is a government takeover of the health care industry. This is what the hard left wants (think Hillary care). As qualified people tackle the problems, solutions will be forthcoming. If workable solutions come from the Democrats it means it has finally cultivated some thinkers not under the cultural grip of the hard left. Frankly, I don’t see it happening but I would welcome it if it did. Conservatives will most likely lead the intellectual work in this area simply because they have a more realistic, and thus reasonable, view of human nature and the workings of government and culture.
Holman wrote: “The conclusion is that people should pay for their own health care. They are supposed to do that with Health Savings Accounts.”
Fr. Hans responded: “Essentially yes.”
As I mentioned before, HSAs simply would not work for that. Medical expenses, even for relatively minor things, can wipe out an HSA in a moment, even for people who can afford to maintain a large account balance. HSAs are utterly inadequate for anything more expensive. It’s not hard to figure; you can work the math. Of course, one option would be to simply refuse medical care to those who can’t pay for it. This may actually be the ultimate goal of Christian-libertarians.
Fr. Hans: “Liberals seem unable to evaluate their ideas based on results.”
It’s the liberals who appeal to the results. In the U.S. we have a shorter average life span than many countries that have some form of socialized medicine. (A while ago I did some research and found that life span in Cuba is slightly longer than that in Texas.) Along with that, our costs per capita are more than double in many countries with socialized medicine. No country is perfect, and there are problems with every system. The existence of problems does not mean that a system has “failed.”
There is nothing in HSAs that would work to reduce healtcare costs, although they would end up bankrupting millions of people, and probably bankrupting a number of hospitals and clinics as well. The suggestions from the “liberals” in moving closer to a single- or fewer-payor system, would actually reduce costs through the elimination of a large number of non-value-added activities and duplication of overhead services.
As I have mentioned before, there is no reason why a single-payor system would have to be “run” by the government. I pointed out that Medicare contracts with private firms to administer Medicare claims, audit hospital cost reports, etc. In general, to the extent that you can centralize and standardize and streamline, medicine becomes cheaper, and If you can do that on a national basis without government involvement, more power to you. So far I have not heard in this venue any suggestions as to how that would happen.
Note 27. The “essentially yes” refers to the thesis that liberals run short on new ideas, not on the viability of SHA’s which I don’t know enough about yet to offer a qualified opinion.
As for liberals appealing to results, remember Hillary Care? Do you really think this dream is dead among hard leftists and Progressives? As I see it, HSA’s whatever their merits or weaknesses, covers only a small part of the discussion.
Dear Father Jacobes:
‘…why should we trust the liberals with health care…education.’
Health care and education are two of the fundamentals bearing on the US commonweal’s mental and physical wellbeing and their ‘pursuit of happiness’. You can not maintain a strong and content society-nation-with a sick and a dumb population.
It would seem, from the current state of affairs, that the conserative ‘health care system’ is now in a state of crisis-the uninsured, the high expenses, the lack of delivery, the overflow in the emergency rooms of America and patients used as the profit centers for provider exploitation. The idea that anyone would degrade a future-unknown-liberal health care system is trying to game the system. Nothing susceeds like failure and lack of responsibilty during the last 6 years of coserative stewardship.
If health delievery is not bound by legal-governmental law-parameters than there will be a extreme lack of context for all thoes concerned who must work and bargain in healthcare delivery.
Since this concerns 300,000,000 people, bipartisan deliberations are needed and not argumentation from preconceived ideological view points. The congess must spend the time that is equal to the impotance of these questions. The present conserative congress and executive has just spent time in a cut and
paste operation. The rhetoric is high for an operatioal low.
In education, the current preconceived ideological results do not match the context of the current reality. School boards made up of opinionated nonprofessionals has resulted in the current disarray of our public school system. If you don’t know where you want to go, you can’t get there from here. Here, again, a slap dash approach of the uninformed won’t work; time at board and governmental levels must be spent as to the necessary need to achieve stated goals and desires. If you think and manifest for all students only from a personal point of view, then all will be lost.
Health Savings Accounts (HSA’s) are a nice financial tool for healthy, middle- and upper-class health care consumers, but they do little to address the rising cost of health care in the United States, overall.
If you look at the health care costs of the American population by individual, you do not see what statisicians like to call, a “bell-curve”, or “normal” distribution. Instead what you see is a “skewed distribution” with a small percentage of very sick people with very high costs and a large percentage of healthier people with low or no costs. Most health care costs are incurred by people who are very ill, often in emergencies. Ten percent of the sickest patients account for about 70 percent of all health care spending. There is not much HSAs can do to impact the use of services by this segment of the population.
The idea behind HSA’s is that by being forced to use their own money, individuals will become more prudent consumers of health care services, and stop using health care frivolously, and without regard to cost. This is underlying justification however is supported only by fallacies:
HSA’s assumes that health care services are elastic, and an individual can decide to forego medical care until a better price can be found, and that such pricing information is readily available.
HSA’s assumes that individuals have the same medical knowlege as their physicians and therefore are capable of challenging or modifying their physician’s recommendations.
HSA’s assumes that individuals have the same bargaining power and leverage to obtain lower prices from medical providers as exercised by large purchasers such as health plans, employers, and the government.
HSA’s assumes that lower income individuals have the same capability as middle- and upper-class individuals to accumulate sufficient funds in an HSA to cover all their co-pays and deductibles. Adults with HSAs, coupled with high-deductible health plans (HDHPs), are far more likely to delay or avoid getting needed care, or to skip medications, because of the cost. Problems are particularly pronounced among those with poorer health or lower incomes.
Note 29. j R Dittbrenner writes:
Agreed, which is why I mentioned to Jim Holman that I would welcome new ideas from liberals (see note 26). However, no new ideas have been forthcoming. Mostly we hear variations of a nationalized system, similar in scope to Hillary Care, which Canada and England reveal has decreased the quality of health care. If ideas are offered that rises above these calls for nationalization, I think they should be considered. But, again, merely reciting the problems of the present system is no justification for nationalization, which, as I am sure you know is the goal of the hard left and Progressives. This isn’t “baiting the system.” It simply is taking what they say seriously.
Education is locked into failure largely because the Democratic bosses won’t allow school choice. In areas where parents are allowed to choose between private and low performing public schools, they choose the private — if they can afford which many cannot. Where public schools perform well, they are satisfied with the public system. But again, the worst schools in the country are in inner cities controlled by Democrats. Washington, DC is exhibit A. Democrat senators against school choice send their children to private schools. I guess it’s OK to let the poor languish in ignorance while their children get the best education possible.
I’m off to Tampa for the day so I wont be able to respond until tomorrow.
Dean writes: “Health Savings Accounts (HSA’s) are a nice financial tool for healthy, middle- and upper-class health care consumers, but they do little to address the rising cost of health care in the United States, overall.”
Dean’s comments are absolutely correct and backed by existing studies and data. For example,
http://www.ama-assn.org/ama/pub/category/15234.html
Here’s the view from Consumers Union:
http://www.consumersunion.org/pub/core_health_care/000882.html
HSAs simply will not do what the right-wing says they will do, and anyone who does five minutes of research on the topic (outside of the Cato Institute and the Heritage Foundation) realizes that.
Fr. Hans writes: “However, no new ideas have been forthcoming. Mostly we hear variations of a nationalized system, similar in scope to Hillary Care, which Canada and England reveal has decreased the quality of health care.”
No one is suggesting that we copy every detail of Canadian or English health care. But these countries, and others with similar systems, have achieved life expectancies comparable to or better than ours, and with health systems with half the per capita cost compared to ours. Surely at a minimum it makes sense to consider whether the basic concept could be modified and used here.
In my observation, the objection to Canadian and other similar healthcare systems is 99 percent philosophical. In current right-wing thinking, the government can’t do anything right, it’s role does not include healthcare, and to suggest otherwise on either point is “liberal” thinking, which has to be wrong. In other words, even if the Canadian healthcare system worked perfectly, the right-wing in the U.S. would still reject it on philosophical grounds.
Note 30, Dean, proponents of nationalization have the burden of proof
Dean, given the abject failure of the Canadian and UK medical health systems, proponents of nationalized medicine have a heavy burden of proof. Proponents of nationalization must acknowledge the deficiencies so bitterly complained of in Canada and the U.K. and provide rock solid reasons why these same problems will not surface here.
Although the cost of medical care in the United States is higher in some cases, the outcome for typical patients is comparable. American physicians studied large classes of cancer and heart disease patients and found that American patients had equal or better outcomes. Given that result we need only worry about people, who for no fault of their own cannot afford insurance. We can provide assistance to people in buying private insurance without nationalizing health care. Methinks, Dean, thou are too in love with the word “nationalization.”
There are many tools, policies and devices that could improve health care in the United States. These policies deserve consideration and a realistic try.
What is curious is that your committment seem so adamantine towards nationalized and federalized medicine. I don’t want my health in the hands of the feds.
We haven’t even begun to promote competition. Remember what I told you about my skin treatment. One physician quoted me $1600 and another quoted me $350. Many hospitals will not make their price schedule available to people before they check in for non-emergency treatment. This effectively defeats attempts to compare price. Many hospitals do not make public the rate of deaths from iatrogenic causes (people who died from infections acquired inside the hospital or people who died from diseases or injuries they didn’t check in with.) America hasn’t even truly tried competition between medical providers, in my case, I got a board certified dermatologist to administer a treatment for $1250.
Note 29, JR is from Germany
Friends, please note that J.R. is from Germany, a country with many, many admirable qualities. Germans are firmly committed to a nationalized health care system. They consider it to be one of their primary values. Unfortunately, for Germany, its economy, once dynamic is stagnant and deficits are growing. The truth is that whatever system Germany has, whatever its virtues and vices, it is not sustainable. Germans have, in my opinion, put their heads in the sand and refused to confront the truth of their system. The balloon will pop one of these days and when it does, watch out, the consequences will be painful.
Americans are different. J.R. is too quick to condemn the American system as a failure. As I noted, the question of what is a successful health care system is complex. I noted the study where large groups of American and Canadian heart disease and cancer patients were followed and their outcomes compared. The American patients did as well and many times better in terms of health outcomes. Did they pay more? In some cases, yes. BUT one must remember that Canada takes 50% of the income of middle income earners. If you earn the equivalent of $40,000 in Canada, the government takes HALF.
So what is the true cost of health care in Canada? Whatever fees Canadian pay to the health system AND half of their income.
Again, true competition has not even been tried in America. It has worked for previously regulated industries like phone and power, it can work for medicine if providers are required to publicy post their prices and their success rates.
Again, JR is not entitled to treat nationalized systems as successes. They are far from successes they are in fact, bankrupct, as we speak. A nationalized system that digs deeper and deeper and deeper into debt is not a success, ask the Brits and the Canucks what that means.
Missourian writes: “Dean, given the abject failure of the Canadian and UK medical health systems, proponents of nationalized medicine have a heavy burden of proof. Proponents of nationalization must acknowledge the deficiencies so bitterly complained of in Canada and the U.K. and provide rock solid reasons why these same problems will not surface here.”
What exactly is the “abject failure?” Every healthcare system has problems. Canadians come here for hip replacements. We go there for drugs. As I have pointed out several times now, Canadians (and other countries with similar health programs) have life expectancies as good as or better than ours, and they do that with per capita costs around half of ours.
Missourian: “We can provide assistance to people in buying private insurance without nationalizing health care.”
Yeah, all 30 or 40 million of them. It seems like you’re changing your tune. Before you were sayingn that it wasn’t the government’s job to provide health insurance, and it wasn’t the employer’s job. Now you say “we” can provide assistance. Who is “we?” You and Fr. Hans?? You can have a bake sale.
Missourian: “What is curious is that your committment seem so adamantine towards nationalized and federalized medicine.”
It just depends if you want to reduce the great overhead cost of medical claims processing, and if you want to attack healthcare costs in a systematic manner.
Missourian: “We haven’t even begun to promote competition. Remember what I told you about my skin treatment.”
With all due respect, providers aren’t interested in competing for uninsured patients. There is already competition, because the reimbursement of medical providers is based on contracts with insurers. They can’t just charge whatever they want — except in the case of uninsured patients. But again, nobody is losing sleep trying to figure out how to attract more uninsured business.
Note 34, JIm, then they compete for insured patients?
You stated that no one wants to compete for uninsured patients, then, you concede that they will compete for insured patients? N’est-ce pas?
Attitude is everything. Our country existed for many years without employer or government supplied health insurance. Employer provided health insurance arose only after WWII because of government imposed restrictions on pay raises. It is important to note this because ….. attitude is everything.
Socialists generally appear damp-eyed and hanky-twisting about how it is impossible, immoral or unethical to expect people to provide some necessity in life: health care, food, housing, transportion, clothing, …. the list goes on.
This is an attitude not a moral posture. People in America are more properous than anyone people have been in the history of mankind, yet, supposedly it is impractical to expect people to save money to cover health care needs. How many Americans own two cars, three TV sets, a RV and have a working spouse? Why can’t they set aside funds for predictable health care needs, which are also those services that tend to be preventative in nature? It isn’t my fault that Americans have a 1% savings rate. We are spenders not savers and we pay the price for that attitude.
In point of fact, many health care needs can be covered by an ordinary savingts program that most people can adopt. The buying power of that savings program can be boosted by government by giving tax-protected status to those funds. Other health care needs can be covered by private health insurance. If selected individuals cannot meet their needs for budgetable health care needs (regular teeth cleanings, for instance) and for major/medical health insurance, it is possible to assist them with something short of nationalization of the entire gigantic system. The fact that 15% of the population is having a problem does not justify allowoing the government to ingest another 25% of our economy.
When government provides everybody lies down and stops trying. As soon as government indicates a willingness to provide any necessity or desirable good or service, the population immediately treats it as a “holy” entitlement and stops even trying to provide it for themselves. Private industry turns to finding ways to squeeze more money out of the government system rather than finding ways to compete with better service and lower prices. We know where this goes.
Two-tier system will remain. Like education, which the government has so badly botched, the rich will get high-quality private health care and the poor will get health care that is so bad that they might as well not have gotten it in the beginning.
Not until your eyes have been bright red for four days: One year, my secretary at a big corporation choose the HMO option for health care. Her eyes became inflamed one day and reached a really disturbing shade of bright, bright red. She called the HMO screening nurse and was told that she would not be seen until her eyes had been red for four straight days because in 60% of the cases, the redness went away in four days. Well, her redness lasted more than four days and she found out that her eyes has suffered from lack of care during that time period. She found this out from a private doctor. This is what government care will be like. The poor will suffer and the remainder of the country will pay outrageous taxes to support the bureaucrats who will hold not just our driver’s licenses but our very lives and well-being in their hands. At that point, God help us all.
The question is not whether health care policy is Republican or Democrat, or whether it is provided by the private sector or government. The question we should be asking is whether health care policies are aligned to a set of social and economic policy objectives and principles.
The sorry spectacle resulting in the passage of the expensive and unwieldy Medicare Part D benefit seemed to incicate that the only objectives health care policy are aligned to at present is the maximization of drug and insurance company profits.
As Mr. Dittbrenner points, the US constitutional mandate to “promote the general welfare” suggests that all citizens should have access to health care regardless of social class or income. So universal coverage should be a policy principle. Economically, the enormous projected impact of the massive unfunded Medicare liability on the federal budget threatens to drive the federal government into insolvency. So slowing galloping health care inflation and promoting greater efficiency ought to be a policy objectivel.
The comprehensive health care reform legislation passed in Massachusetts earlier this year and signed by Republican Governor Mitt Romney, suggests that Government need not “take over” health care, but can serve a useful role by regulating, incentivizing and otherwise coordinating the private health care market to meet policy objectives.
The conservative Heritage foundation notes:
The Significance of Massachusetts Health Reform
Note 36, Dean, the Islamic scholar, now turns to the U.S. Constitution
As Mr. Dittbrenner points, the US constitutional mandate to “promote the general welfare” suggests that all citizens should have access to health care regardless of social class or income.
Dean, you have no authority for such a proposition and, in fact, the Founders would have gagged on the proposition you assert.
Again, only a small percentage of the American population does not have health insurance and the absence of health insurance is not the same of lack of access to health care. We have a 1% saving rate but we own cars, TV’s, boats, watches and much more. We also have imported “poverty” from Mexico, 12 million people illiterate in both Spanish and English with only primtive skills. These people have been dumped on our generous emergency room system, choking it out of existence in high immigration states such as California and Arizona. Los Angles is losing emergency rooms. Want to help the health care “crisis” enforce immmigration law and send the free riders home to their decrepit, corrupt, socialistic country.
Dean’s giant Golden Calf is idea of yet more power to the government bureaucrats. Being a socialist means you never have to admit failure or mistakes. Dean’s proposition would require the level of taxation endured by the serfs and salves of Canada and the U.K., that being, 50% or better. When the government takes 50% of what you earn, you are no longer a free person, you are a serf of the system.
Dean goes from National Health Care to Free Market proposal in only 24 notes
Note 14: Dean argues for “National Health Care.” This term is generally understood to represent a nationalization of health care by the federal government. It would be the biggest adquisition of financial power by the federal government in U.S. history.
Note 36: Dean now argues for creating effective markets to allow competition.
I guess I just have to pat myself on the back for converting Dean from a socialist to a free market proponent. Whoda Thunkit
Note on preventative health care: This is precisely the type of non-emergent health care which can be scheduled with no harm accruing to the patient. The cost of this type of health care can be estimated and budgeted on a yearly bais. It is precisely this type of health care that the average American can create a savings account to cover. Tax-sheltered health savings account can reduce the financial burden of setting aside the patient’s own money. Most adult Americans would greatly benefit from this type of approach. It isunderstood that HSA’s are rarely adeuate for catastropic health problems or major medical, but, wisely used they can greatly reduce the need for medical services. Catastrophic health care problems and major medical can be covered by insurance.
Note to Jim Holman: S-A-V-I-N-G. The policy of consuming less than one earns and setting aside the excess to cover unforeseen negative contingencies. This practice is discouraged in heavily socialized economies through heavy taxation and the false promise of government to “take care of the citizens.” Saving is also based on the principle that adults understand that the rainy day will come to us all and that we are responsible for doing what we can to provide for that day without burdening our neighbors.
Note 36, Dean and Dittbrenner totally incompetent to interpret the “Promote the general welfare” of the Preamble to the U.S. Constitution
Please note that this post addresses Dean’s assertion of expertise in U.S. Constitutional Law. This assertion is fully and totally unfounded. All readers of Dean’s posts should remember this unfounded assertion of knowledge, particulary when he opines on many policy issues. As Gertrude Stein said “there is no there there.”
Here is the Dean quote repeated from Dittbrenner.
As Mr. Dittbrenner points, the US constitutional mandate to “promote the general welfare” suggests that all citizens should have access to health care regardless of social class or income.
As a quick response I pointed out that Dean had zero support for this assertion.
My authority is James Madison, generally credited as the author of the U.S. Constitution.
The General Welfare
Perhaps no phrase found in the Constitution has been more distorted in actual use and application than the provision that one broad purpose of our government is to promote the general welfare throughout the United States. The Constitution’s Article I, Section 8, assigns Congress the “power to lay and collect taxes … to pay the debts and provide for the … general welfare of the United States.” Certainly, if the Founders had meant this purpose to include any action that might possibly benefit citizens generally, the Constitution itself could have been limited to this solitary statement. Justice, defense, and liberty, after all, are of good effect on the general welfare of the nation as a whole.
But the Founders also ratified the Constitution’s 10th Amendment, affirming, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.” Thus, the general welfare cannot reasonably be stretched to allow the national level of government to perform functions and exercise powers beyond those specifically and explicitly listed in the Constitution. As James Madison described the limitations on interpretation of the general welfare clause, “If Congress can do whatever in their discretion can be done by money, and will promote the general welfare, the government is no longer a limited one….”
Please also note that I have provided Fr. Jacobse the background information on my legal education and bar membership. If there were no member of the bar reading the post from Dittbrenner and Dean, they would apparently both proceed to pontificate on the Constitution with virtually no real knowledge or expertise. Next time Dean pontificates about the best policies to adopt regarding Islam please keep this in mind. This is a form of intellectual dishonesty.
Quote: Sources for quote on the U.S. Constitution
The central two paragraphs of my last post consists of a quote from
the following website:
http://reagan2020.us/platform/the_general_welfare.asp
Please note that the most important aspect of my note is the quote from James Madison who clearly understood that Dean’s interpretation would destroy the conscept of limited government.
Dean’s approach to every domestic issue is to federalize and to expand the role of the federal government. His approach is fundamentally and totally in opposition to the intent, spirit and content of the U.S. Constitution. There is no quote in U.S. Consitutional law which is repeated more often than that the federal government is a government of limited powers. Dean has no knowledge, appreciation or respect for this and it is the very most central point of the the U.S. Constitution.
Readers beware.
“The question is not whether health care policy is Republican or Democrat, or whether it is provided by the private sector or government. The question we should be asking is whether health care policies are aligned to a set of social and economic policy objectives and principles.”
I agree! Now, given the fact that the market economy is almost always the best way to deliver anything we should never, ever allow the government to gain more control over medicine than it already has (i.e SS, Medicare, Medicaid, etc.). By “best” I mean two things:
1) Morally or Christianly: market economies, with mild regulation by the state, are the best way to organize human relations in that they fit naturally into human freedom and responsibility given to us by the Church. Given Christian Anthropology, statist policies are clearly evil.
2) Efficiency: In pure “greatest good for the greatest number of people” terms, market economies are clearly superior.
Now, why do you insist on reducing the quality of medicine in this country by supporting policies that meet an unreal ideal of yours: egalitarianism? Because you do not have Christian concept of man and how man is to relate to his neighbor. You substitute a modern conception of “fairness” for everything the Church teaches us about man.
In other words, you are ok with bad medicine because some concept of “fairness” trumps all for you (even to the extant that it is what you think of when you read our Lord’s commandments, such as “do unto to others…”). You even read it into the constitution here:
“As Mr. Dittbrenner points, the US constitutional mandate to “promote the general welfare” suggests that all citizens should have access to health care regardless of social class or income.”
It suggests no such thing!! What the constitution actually says is secondary to your overriding goal and worldview: bland egalitarianism. Indeed, your wish to “reduce abortions” can probably be tied to your wish to reduce medicine.
Dean, until you decide to address this philosophy of yours, and the non-Christian anthropology from which it arises, Christians are going to keep disagreeing with your for Christian reasons…
Dear Worker-Bee,
Please note: 42 years was spent working in the USA health care and delivery systems. This includes hands on delivery as well as applied research. I do travel a lot. At present the health care delivery systems of many European countries are being reviewed, revised and augmented to preventive medical care for the total population of each country.
There is a different mind set at the citizen level of the European. An example: Why do the Swedes speak Swedish and not English? Syntax gives you different thought variations and constructions. Why do the Chinese think of themselves as the Central People? The Icelandic people think that The US congress is a Johnny-come-lately in relation to their parliament. Different people have entirely different frames of reference, some 2 or 3 thousand years old.
Country and work comparisons are of limited use for a very short period of time. If you were to compare the national public debt the US to Finland, the US debt is far higher off than Finland.
Health cost per unit of delivery is still costing the US about twice as much as the average in Western Europe. It is the Federal Government that has so upended the playing field for the consumer: i.e. the corporate profit center. Germany uses health insurance carriers; the people pay money in and get good medical care out. The government helps the indigent with their premiums.
Oh well, take from there.
Sincerely, J R Dittbrenner
Note 39, Hey, JR
JR, my comments have been aimed at three things:
A) Dean’s very long term advocacy of federalization of all health care in America
B) the assertion that Europeans have solved the problem of providing good health care
C) the assertion that health care is cheaper in Europe.
Response to A: Proponents of federalization should have the burden of proof since the Social Security system of the United States is dysfunctional and will either collapse in its entirely OR have to be completely revamped in just a few years. Given that the federal government has not handled these massive programs well, no rational person would give them yet another rational program to manage regardless of the theoretical or academic reason advanced to do so.
Response to B: The European systems are in nearly the same shape as the Society Security system of the United States. Economics on both sides of the Atlanic have described the European systems, including the German system, as unsustainable and on the verge of financial collapse. Basically, the European systems are out on a financial limb and are living on borrowed money. All looks good until the system finally implodes.
Response to C: The standard of living in the United States is substantially higher than that in Europe. I have been there and although the land itself is very beautiful and although the Euros have done a good job of preserving many historical landmarks, the living conditions of middle class Europeans are quite below those of middle class Americans. At this point in the discussion someone always pops up and says that you have to give Europeans a BOOST because of the availablility of cheap health care. However, no one every reminds us that you have to give Europeans a DEMIRIT because in order to get this “free health care” Europeans have to pay taxes that are nearly unheard in the United States.
Again, I have great respect for the German people. I am open to learning from what Germans have learned in their country and their experience, but, it is nonsense to suggest that Germans or any other European have found the “simple gold answer” to the problem of providing adequate health care.
Hint, this world is not a paradise and will never be made on by human efforts, however, much damage has been done attempting to create a paradise that will never fly.
Germans taxing their economy into the ground
I have a long term business relationship with a German computer scientist who is capable of producing truly brilliant software. He lives just outside Heidelberg the famous University town. He is a loyal and patriotic German and has no personal desire to leave Germany but he has looked into emigrating to the U.S.
Why?
He cannot hire an employee without paying that employee the equivalent of $40,000 U.S. Once an employee is hired, his options are severely limited if the employee is just plain lazy, unproductive, disruptive or even criminal. It takes work to remove a criminal from the payroll under the existing labor laws. That iswhy he wants to move to the U.S.
The productivity of this fine business is being strangled by the labor and tax laws, consequently Germany is poorer because these brilliant German computer scientists can’t properly function and run a very simple, clean business.
I hope this gentleman comes to the United States he will add greatly to our GNP.
Dear Worker-Bee,
I am not from Germany, I am from Texas. I have lived and worked in every US state except the New England states in the continental 48. One of my degrees is in History with a special Historiography of the writings surrounding the Constitution. The pursuit of happiness only guarantees the pursuit of happiness, not the guarantee of happiness. Nothing about medical care is mentioned in the Constitution. Abortion is not mentioned and neither is stem-cell research; etc.
I do not judge my self as that incompetent in relationship to the founding and promulgation of the constitutional efforts of our founding fathers-one must in include Abigail and other wives also. The Federalist Papers were a High School read in 30s and 40s in the USA.
I am not a proponent of so-called socialized medicine-the US Navy was that. There are systems that do a better job of delivery than OURS at a lesser cost. Constant adjustment to any social system is the necessary ingredient to success.
Sincerely,
J R Dittbrenner
Christopher: Please elaborate – because what it sounds like your saying is that real Christians are perfectly content to watch their fellow citizens (perhaps a Samaritan lying injured on the side of the road) suffer without access to health care.
But a person who wants to use the most powerful and effective means at our disposal -the power of government – to expand access to health care and minimize the number of people suffering for lack of access – cannot be a Christian, but must be a “materialist”.
This is bizarre and makes no sense.
Note 43, Dean teaches that Big Government is Christ’s preferred instrumentalilty
Christopher: Please elaborate – because what it sounds like your saying is that real Christians are perfectly content to watch their fellow citizens (perhaps a Samaritan lying injured on the side of the road) suffer without access to health care.
But a person who wants to use the most powerful and effective means at our disposal -the power of government – to expand access to health care and minimize the number of people suffering for lack of access – cannot be a Christian, but must be a “materialist”.
This is bizarre and makes no sense
Dean’s eternal and unchanging presupposition is that Christian may only fulfill their duty to care about the sick THROUGH government.
His second presupposition is that government is the”most powerful and effective means at our disposal.” This demonstrates the Leftist fast resistance. We have a history of one social program Social Security which is in shambles. We have European governments warning their citizens that the health care systems cannot be sustained and must be radically revamped. We have plantiff crys from the U.K. and Canada about people DYING on government waiting lines for services readily available in the U.S. YET, Dean still insists that government is the most powerful and effective means to address health care. Hence, Dean’s real “god” is government, the answer to all and the instrumentality of Christ.
Yet, of course, this cannot be correct as for 1900 years of Christian history there did not exist any government that even attempted to provide all the health care needs of it citizens through centalized, government-run programs. Therefore, Christ came to Earth to CREATE LARGE GOVERNMENT as a INSTRUMENTALITY for His Work.
Although I have discussed various types of GOVERNMENT POLICIES that would promote competition among health care providers and among health insurance companies, Dean, dismisses that use of government policy. I support the intelligent use of government policy, however, I oppose the complete federalization of American health care, it would be one unholy disaster.
Again, Dean, always arrogates to his big government policies the cloak of Christian charity. His premise is that Christ’s instrumentality is big government, the essence of the Gospel, of course.
Christopher writes: “Now, why do you insist on reducing the quality of medicine in this country by supporting policies that meet an unreal ideal of yours: egalitarianism?”
You mistakenly assume that better access to care would reduce the quality of medicine. It wouldn’t. In many cases it would actually reduce total cost because people would have better access to preventive care. For example, control of diabetes is cheaper than amputations, blindness, kidney failure, and disability. Forget about equality and fairness; better access to care is good medicine.
The problem is that your position is ideologically driven. It’s all based on abstract and debatable economic, philosophical, and theological principles. You seem to know little or nothing about the financial side of healthcare, and you seem to have little interest in learning about how it actually works from those of us who have spent years in the field.
I’m really sorry that healthcare doesn’t actually work the way that your economic and religious fantasies dictate that it should work. I wish it did, because everything would be much simpler and easier to fix. But it doesn’t.
Missourian writes: “We have a history of one social program Social Security which is in shambles.”
It is current in such a “shambles” that the federal government is borrowing the surplus that it generates. Too bad we don’t have more shambles like that. True, long time there are serious problems that have to be addressed. But then there are many other long-term issues that have to be addressed. So I wouldn’t call it a “shambles.”
Missourian: “We have plantiff crys from the U.K. and Canada about people DYING on government waiting lines for services readily available in the U.S.”
You spend your days crying over England and Canada, while we have people here who can’t afford the medicines prescribed for them. We have people dying because of their lack of health insurance:
http://www.scienceblog.com/community/older/2003/B/20036858.html
http://mitsloan.mit.edu/newsroom/2003-doyle.php
http://www.denverpost.com/news/ci_4144600
http://www.medicalnewstoday.com/medicalnews.php?newsid=23882
Hell, I don’t even know why I try. Folks like you and Christopher are basically immune to the facts. This whole discussion has become a waste of my time. I only worked with this stuff for 21 years, but so what. You expect people to fall down in admiration every time you hold forth on the Constitution, but when other people try to share their expertise you retreat into conservative Disneyland. Enjoy the fun; I don’t have time for it.