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.
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Dean says:
“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.”
You see what I mean Dean? You have great difficulty separating the commands of our Lord (i.e. Samaritan) from modern socialist and egalitarian ideals of government (i.e. socialized medicine). You see the two as one and the same. Real Christians can “Render unto Caesar” and yet obey the Lord.
“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”.”
That’s right. It is to assume materialistic ideas of man and man’s relationship to his neighbor and his God. By the way, the government is most definitely not the “most effective means at our disposal”. Socialism fails every time it is put up against a market based economy (one’s with the rule of law).
“This is bizarre and makes no sense.”
I know! The progressive view of man is so, so yesterday…;)
Note 51. It’s also the Progressive’s favorite tactic. Find flaws in the present system and feign moral outrage about them, but avoid any engagement with the real world consequences of Progressive ideas.
Given the destruction that Progressive ideals have wrought in the world this past century, I’d take the charge that not supporting universal health care is tantamount to letting the beggar die on the road with a grain of salt.
Note 53, Jim Holman, understanding what a legal opinion is:
Jim, you should acquaint yourself with the meaning of the term “legal opinion.”
A “legal opinion” is a distinct and well-defined entity with a fixed and definite meaning. Unfortunately the term “legal opinion” contains the word “opinion” which tends to confuse the non-legal layperson. The primary distinction of people who have met the requirements to practice law under the laws of a State of or the Federal government is that they have shown that they are qualified to give legal opinions.
A legal opinion is a summary of the current state of the law as applied to a particular question. It is actually an objective statement not an “opinion” in the ordinary sense of that word. There is much confusion on this point.
Example, you might have a boundary dispute with your neighbor and you might ask an attorney for a legal opinion concerning the dispute to determine exactly what your rights were. The attorney would review any constitutional provisions, statutes, contracts, deeds, local ordinances and other legal authorities to determine exactly where you stand.
People who have not graduated from law school are not qualified to give “legal opinion” on the meaning of the U.S. Constitution. They don’t know what they are talking about. The term “legal scholar” is restricted to those who have graduated from law school.
I don’t give theological opinions or medical opinions, however, it is correct that my opinion on the U.S. Constitution does carry weight because interpreting the law of the United States of America is the way I make my living every day.
Does this clear things up for you?
Jim Holman, experience in the health care field and public policy
Jim, I have a good friend who is an emergency room nurse. She has some valuable insights into health care that I don’t have the background for. However, working as an emergency room nurse does not make her an expert in what is known as “public economics.” Public economics is the branch of economics that deal with the economics of public programs and how they affect the private economy.
The medical care is “free” but you will die before you get any
Jim, the proponents of a truly nationalized health care system have to address the failings of the U.K. health care system and the Canadian health care system at a minimum. The other Euro systems are close to economic collapse. Imitating them without identifying the solutions to their problems would be extreme idiocy.
The U.K. health care system is currently undergoing volcanic turmoil because its cost to the public has been increasing by 10% to 15% per year. The U.K. health care system is literally eating up the public treasure. At the same time, waiting lines for treatment are growing.
Important as health care is, the country also has to spend on defense, education, transportation, the regulation of industry and commece, etc. In the U.K. the percentage of the public budget being consumed by the NHS continues to grow at an astounding rate with no one having a clue of how to reign it in. This cannot go on forever and it appears to be about to crash.
No rational country would imitate the NHS.
My conservative friends seem to forget that private business entities do not exist to further important social goals – they exist to maximize profits for their owners. Therefore, if our nation wishes to address, rather than neglect, urgent national problems, an active role by our government is required.
Structural problems in our health care system increasingly loom as urgent national problems. As I mentioned these problems include 16% of our population, or 46 million people are without health insurance. Inefficiency and near double-digit annual health care inflation, which impacts programs such as Medicare and Medicaid, threaten to overwhelm federal and state budgets.
Today’s NY Times has a good article on the desperate attempts by some hospitals in Texas to provide care for the uninsured.
To Lower Costs, Hospitals Try Free Basic Care for Uninsured
It is a cry that will go answered so long as conservative ideologues are in power.
When will conservatives realize that neglect is not a solution, but an abdication of moral and social responsibility?
Note 56. Dean writes:
There you go again. Attack motives rather than engage ideas to imply that Progressive social engineering is the cure for all that ails society. The problem is, that Progressive ideals have caused more suffering in the world than any other ideology. It has institutionalized poverty, has diminished health care in countries with nationalized medicine (people die waiting for an operation); destroyed education in the inner cities, justified millions of abortions (thereby undermining the voting base of the Democratice party); undermined the sanctity of the family; not to mention the millions dead through Marxist central planning and other statist dreams.
One thing is certain. Follow the Progressivist dream, and the end is always worse than the beginning. Like any statist program, the spoils go to those at the top at the expense of those at the bottom — just like inner city education, a national disgrace that benefits only the teacher unions; the institutionalized poverty that serves only the political operatives who control the welfare payouts; the elevation of the vanguard of Marxist regimes while the poor starve, and more. Are we really to believe that the operatives who pull the levers of nationalized health care will ever put themselves on a waiting list? Are we to believe that they will be short of necessary drugs? Are we to believe they will sacrifice their own welfare on behalf of the poor? They have not done it yet. There is no reason to believe they will start now.
Texas has problems with health care because of the illegal immigrant population. To argue that this influx shows the chronic ills of the present system is disengenous, but again not suprising since the purpose here is not to examine the real reasons for the problem, but to impose another horribly flawed social engineering scheme.
Your ideas won’t improve health care, Dean. They will simply degrade present care into an egalitarian mediocrity. We don’t want Progressives to do to health care what they did to education or welfare. We want the problems fixed. We just don’t trust you (or you cohorts at the Nation) to do it.
Note 56, Dean, private profit promotes low prices,socialism rations by waiting lines and political influence
My socialist friends tend to forget that competition produces low prices and higer quality, that is why America is so much wealthier than Europe and the rest of the world. Love the moral condescension combined with economic ignorance.
Walmart is the bete noir of American liberals yet macro-economists have estimated that Walmart alone is responsible for a full percentage decrease in the Consumer Price Index. For perspective the CPI usually ranges from 2% to 4% so a full percentage price decrease is significant. If the price of food and ordinary household goods is reduced by 20% which is what the 1% in CPI means, then the poor benefit the most because they spend the highest percentage of their income on food. Dean doesn’t want that to happen he wants higher prices and restricted employment and more power for the government through forced benefits for Walmart workers. This deprives poor people everywhere access to inexpensive food and household goods.
If my socialist friends would read one of the great classics of world literature: The Wealth of Nations by Adam Smith, they would understand how economics works. They simply do not understand, and refuse to understand. A profit motive produces better results for consumers of whatever produce or service, health care is no exception. IF a consumer has absolutely no purchasing power, he can be selectively assisted, however, the answer is not to kill the mechanism that produces high quality and low price.
Our health care costs are high BECAUSE we lack a competitive market for health care serivces. Case in point. Many surgeries are elective OR can be scheduled on a non-emergency basis. This doesn’t mean that they are not crucial, it just means that there is time to compare prices. Hospitals routinely REFUST to post prices for the care they provide. Consequently, the cost of delivering a healthy baby at an accredited hospital can vary in the same city from $3,000 to $12,000. IF PRICES WERE POSTED the high priced hospital would have to compete and lower its prices. The existence of extreme divergence in prices is PROOF of the absence of price competition. No one would spent $20,000 for a PC because everybody know that Best Buy will sell you one for $1500. This is the simple truth of price competition. Ask yourself what would be the result if every hospital had to post its prices for standard services? Would you check those prices? Would you agree to pay $12,000 for a standard delivery or would you go to the hospital that would deliver the baby for $3,000
The first policy priority is to promote the same price competition in medical services that keeps prices for paper, cars, computers, books and other goods low. The second policy priority is to promote price competition among health insurance companies to keep the price of health insurance low. The third polcy prority is to assist a very small percentage of people who lack the means to purchase major/medical insurance. This is less than 16% of the population because Dean is quoting the 16% figure as the percentage of people who lack health insurance. Remember, you don’t have to have enough money to pay for health care, you have to have enough money to pay for health insurance.
Dean wants to parlay 16% of the population who does not have health insurance into federalization of the entire national health care sector. More power for government is always Dean’s agenda.
Dean suggest without proof that socialism would put the interest of the patient first. This is simply not true, the NHS is bankrupct and the lines as so long that people die waiting in line for treatments that could have saved them.
Dean desperately wants us to avert our eyes from this debacle.
Socialism and socialistic policies always, always, always makes us poorer. With respect to health, it will make some of us dead before our time.
Price shopping, a quiz
Question, how many readers of this blog do the following:
Visit several stores and note prices before buying a TV, a couch, a bookcase?
Answer? Everybody
Check the web for prices on common consumer items?
Answer? Everybody
Visit several dealerships before buying a new car?
Answer? Everbody
Call 10 hospitals in your metropolitan area and get a price quote for
the cost of a hospital stay?
Answer? Probably no one
Would anyone who has shopped for non-emergency medical services, please raise their hands? Anyone? I did and I found that the prices ranged from $350 to $1600 for the exact same service by board certified medical personnel. Hmm, how odd, this type of price differential means that there is no functioning market, no price competition.
The virtue of importing poverty through open borders, Dean’s genius
Dean’s expresses legitimate concern about the cost of paying for care for people without insurance. However, Dean also supports a policy that imports 12 million destitute people from Mexico which by default piles 12 million indigents on our emergency medical system. However, being a socialist means never having to account for the consequences of your proposed policies, so when medical care issues come up, there is no mentio of the strain on emergency medical services.
Remember in 2005 4 Los Angels emergency rooms closed because they could not keep up with the demand for free health care from the illegal aliens flooding their waiting rooms. Any emergency room medical professional will tell you that illegals have no compunctions about arriving at an emergency room and demanding care for illness which are a) not true emergencies and b) simply the result of prolonged medical neglect, such as an infected tooth. Illegals use American emergency rooms for routine care and are unlikely to stop until those emergency rooms shut down, which they have in L.A.
So importing this poverty through open borders assists socialists in obtaining more votes for entitlement programs AND creating the poverty needed in America to support more federalized programs. Without the 16% uninsured figures Dean has no case to argue. Illegals immensly assist this agenda.
Note 58. Missourian. Another example. When my baby was delivered by C-Section, I got a bill that seemed awfully high. I called the hospital and requested an itemized breakdown. They replied they don’t out itemized bills. It took two weeks to move progressively up the food chain until I finally got it. Looking it over, I saw a $3,000 or so charge that did not belong there. (C-sections require a neonatal surgeon on standby in the operating room. He never made over from the hospital across the street.) I protested the charge and it took another two weeks to resolve it (I made them go ask the surgeon if he really was there; they didn’t believe me that he never was there even though I was in the operating room watching the entire procedure). Finally they removed the charge.
You point is taken. Medical economics operates like a closed club. How many people would have paid this charge because they never looked at the bill?
Another point. If health care is nationalized, it will inevitably be hyper-politicized. Look at the Michael J. Fox debate and how embryonic stem cell research has been injected into state races. Imagine the agitation from the hard left if medical decisions end up in the hands of government appointed bureaucrats, and the pressure that would be brought on families to abort and euthanize, especially as prices spin out of control and eliminating the person makes “economic sense”. It would be a end run around the legislature on sanctity of life issues, similar to the activist judiciary. I don’t doubt that this shapes some of the appeal of nationalized medicine, ie: social engineering dreams versus real concern for the health of real people.
The Price of Calculators OR Does Hewlett Packard really care about me?
When I was in high school electronic calculators were large, sat on a desk and could cost more than $100.00 . All they could do was add, subtract, multiply and divide. Today, long after high school, I have a Texas Instruments TI-92 which I can carry in my purse. This calculator is programmable and has a screen which can display 3D graphics. It has hundreds of features including advanced engineering mathematics such as Fourier transforms. Wowee, kazowee, it only costs $95 yet it is close to a PC in capacity.
Texas Instruments (TI) produced this improved calculator based solely on the profit motive. Other than wanting my consumer dollars TI doesn’t care about me. Neither does Hewlett Packard. But HP and TI keep competing to produce faster, cheaper and more capable hand-held calculators and I can tell you the result is really great for me. My work is easier and I am far more productive as a result of the profit motive.
Dean’s approach: Dean discovers that there exist some people who do not have the funds to purchase the latest hand-held calculator. His solution is not to selectively assist those people who are in genuine need of a calculator BUT to shut down the process which produced the fabulous TI-92 model upon which I depend daily. He wants all calculators to be produced by government and handed out to people based on the government’s criteria. We all will be taxed to produce the calculators whether we use them or not. The government will be far less efficient in manufacturing the calculators because they are a monopoly. Monopolies are so bad that they are illegal under the Sherman Anti-Trust Act, but, we still somehow endorse government monopolies.
In the absence of competition, the government will have no incentive to improve calculators, just as the government has no incentive to improve the excreable service it provides at the DMV. Enjoy the DMV? Would you like the DMV to take care of you when you deliver your baby? If not, why not you selfish conservative.
Note 61, Congratulations, Fr. Hans
I salute your perspicacity!!
Something tells me that the hospital personnel that you dealt with treated your requests as outlandish.
Did they adopt an attitude of chagrined annoyance at your persistance?
Did anyone apologize about carelessly over-charging you to the tune of $3,000?
Note 62. They treated my wife (she did most of the work) as a second class citizen, like a person attending a black-tie affair wearing a dress from Wal-Mart. They were condescending and dismissive. The worst were the telephone clerks. One she got higher up the food chain, the people understood they were dealing with someone determined and started responding. (My wife doesn’t let people push her around. You’d like her Missourian.)
Frankly, the billing department just didn’t like being questioned. It wasn’t so much about catching the mistake, but that someone would even dare challenge them about it.
No apology was ever made. I would have been fine with the apology since mistakes inevitably happen. This just could have been an oversight. No apology though told me the problem was part of the hospital culture.
Note 64, I remain in awe of the accomplishment
Your wife’s example is an inspiration to us all
Boy, it must have been a real headache to persist and prevail. Again, real congratulations.
Those who believe that there will always be an endless supply of money to fund the unfair and inefficient health care system we have now are living in a fool’s paradise.
The remorseless rise in health care costs, the gradual collapse in employer-based insurance, plus the aging of the baby-boomers into the decade and half before Medicare cuts in at age 65 – when health insurance gets really expensive and hard to get – means that a day of reckoning is bearing down upon us. More people are going to find themselves without health insurance, while rising costs will make the very rationing of services that opponents of national health care decry, a practical neccesity.
Health Care Economist Matthew Holt writes:
Why Is Fixing American Health Care So Difficult?
American Health Care System Has Many Powerful Interests Competing
So we can fix the US health care system or have the kind of health care they have in Brazil, where the rich get all they want and the rest of get to throw ourselves at their mercy as charity cases or die.
Missourian writes: “However, working as an emergency room nurse does not make her an expert in what is known as ‘public economics.'”
I am not an expert in public economics, but I have a reasonably good grasp of a number of the details of the financial side of healthcare. I started as a patient account analyst, working with the details of Medicaid and other public agency reimbursement. I did purchasing for outpatient clinics and the emergency room. I worked for eight years as an analyst in the financial department, doing managed care contract reporting and evaluation, rate increases, working with physicians on research studies, doing program cost analyses, producing legislative exhibits, and so on. I spent 10 years working on process improvement, and cost control related to patient supplies and other support services.
In short, I have a good grasp of how things work at the nuts-and-bolts level. For me, medical cost-saving is not an abstract concept that I read about on the Heritage Foundation web site. It is something that I spent years doing, at both the clinical and support services levels.
So when I hear someone say that “the government” can’t do anything right, that everything they do is bloated and more expensive, that they can never be trusted, etc., etc., I know that this person does not know what he or she is talking about, because I’ve seen specific instances when government medical programs brought about impressive efficiencies and cost reduction. When someone says that more competition is the cure-all, I know that that person does not know what he or she is talking about, because I’ve seen very specific examples where more competition brought about increased costs and a decrease in quality. The little one-liners about how bad government is and how great the private sector is sound impressive, but they often have little to do with the reality on the ground.
Personally, I don’t favor a more centralized approach to healthcare because I think it would be “fairer” or “more egalitarian.” I don’t favor it because I like bureaucrats. I don’t favor it because I’m a “leftist.” I favor it because I see it as the best way to reduce non-value-added activites and overhead costs. I favor it because I see it as the best way to ensure that people are getting at least a minimum standard of care, thus also lowering costs down the road (e.g., prenatal care, diabetes control, etc.) I favor it because I see it as the best way to begin to decouple health benefits from employment — which served us well for many years, but increasingly does not. At the same time I’m not a fanatic about government involvement in healthcare, and I believe that the private sector will always be the most important component. In fact, I was on many projects working WITH the private sector to drive cost out of the supply chain.
Concerning Missourian’s medical cost-shopping — The medical system in the U.S. is not optimized for quoting prices to uninsured patients. Most of the payments to hospitals and medical providers by insurance companies are based on standard fee schedules set by contract. So the physican or the hospital can charge whatever it wants, but the payment is fixed by contract. People in the hospital that I used to work at called patient charges “funny money,” because it had little or no relationship to the insurance payment. Of course, it’s not funny to the uninsured patient who gets stuck with the bill, but then as I have mentioned, providers are not interested in optimizing their billing systems in order to attract uninsured patients.
So when you see a wide divergence in charges between providers, that doesn’t signify anything, except that some uninsured patients will be screwed. For those with insurance, the providers are getting around the same payment based on the standard fee schedules.
This is one reason why you can’t apply simple economic principles to healthcare.
Note 66, Economic principles always apply Jim
Economic principles always apply Jim. Economic actors, unless constrained by outside influences, will act to minimize cost and maximize value. The pricing system you described is an economic response by the hospitals and the health care providers to the pricing system set by the insurance companies.
I am aware that insurance companies tend to set prices for insured patients and that hospital dump the remainder of unfunded costs on uninsured patients. This is why I pay for health insurance with a very high deductible, I want to get the “insured” prices for my health care.
The only system which consistently keeps prices down and quality up is price competition. Without an economic incentive to be efficient, no institution will try to improve its productivity. Perhaps legislation which requires health care providers to charge the same fees for the same services regardless of the class of patient could help restore some sanity to the system.
It is quite possible that the standard patient charges would no longer be “funny money” if prices and insurance compensation were open and transparent.
I think Americans will resist shopping for health care services becuase most of us want to stick with our favorite physician regardless of price and simply go to the hospitals at which that physician has privileges. We look to our insurance company to pay for our choices regardless of their economic wisdom. We have a system where the consumer is not the payer.
Look at another market in which insurance pays a huge role: car repair. Most people carry car insurance and that insurance pays the bulk of any repairs for damages due to accidents. Car repair shops quote prices and compete on price none the less. Why is there no “car repair” crisis? I think it is because people are willing to shop for car repairs, but, perhaps not for health care. We want to pick our favoriet physician then stick with him/her for the rest of our lives regardless of price. We want the insurance company to pay for our choices regardless of price.
We need a system with real prices, those prices have to be public and transparent, and the person who pays the price of health care makes the choice of health care provider. Americans may need to accept the burden of some shopping around if they want to reduce the cost of health service overall.
Missourian writes: “Economic principles always apply Jim.”
Let me give you can example of a counterintuitive situation where competition raises cost and lowers quality. Hospital A has the only cardiac transplant program in the area. They do around 30 transplants per year, which is enough to support a transplant program staff, and enough to get good experience caring for the patients.
Then Hospital B, not to be outdone, says “we want a transplant program too!” So they start a program. Now, the patients are split between two hospitals. But there aren’t enough patients to support two transplant programs, either financially or clinically. So in place of one good program in which the overhead program costs were easily covered, now you have two weak programs in which the overhead costs are distributed over half the number of patients, and neither hospital has enough of a patient load to give first-rate care.
Now you might think that when only one hospitals provided heart transplants that they could charge whatever they wanted. But it doesn’t work that way, because Medicare, Medicaid, and commercial insurers are going to come in with their fee schedules and get a reasonable deal. And if the hospital doesn’t go along with that, the insurers will send patients elsewhere. So in that sense you do get downward pressure on prices, even though it doesn’t come from classical competition.
Missourian: “I am aware that insurance companies tend to set prices for insured patients and that hospital dump the remainder of unfunded costs on uninsured patients.”
. . . and uninsured patients return the favor through bad debt.
Missourian: “Without an economic incentive to be efficient, no institution will try to improve its productivity.”
But the incentives are there through the control of limited insurance, Medicare, and Medicaid payments. The problems many hospitals have in that context is trying not to go out of business. Where I live we’ve had several hospitals close their doors in recent years. That speaks to me of some pretty serious competition. A hospital closing is not necessarily a bad thing, except in rural areas, because it leaves more patients for the remaining hospitals.
Note 66. Dean writes:
Dean, let’s assume your assertion is true for the time being. Where is the money going to come from if we follow your solution to nationalize health care? Certainly not from the efficiences of government management (we know that does not really exist witness Canada, Germany, England, etc.).
Or do you believe nationionlizing health will suddenly free up more money?
I think what you are trying to say, well, on second thought, I can’t really figure it out. Are you talking about declining markets? The phrase “supply of money” doesn’t make any sense here. It sounds as if you think that if government takes over a service it somehow becomes free of real costs.
How do you jump from the underinsured to a government takeover of the entire health care establishment? Rationing of services? It’s England and Canada that are already rationing theirs Dean, yet you argue we should copy their systems.
See what I mean about ideology overtaking real facts on the ground in Progressive thought?
Fr. Hans writes: “Where is the money going to come from if we follow your solution to nationalize health care? Certainly not from the efficiences of government management ”
There are all sorts of options other than a total nationalizing of healthcare. In other words, it’s not like one day federal bureaucrats are going to march into your doctor’s clinic and take over.
Look at the Medicare program. Medicare is a single payor, but the actual Medicare program is administered by different contracted insurance companies and providers around the country. Where I live you can be a Medicare patient and be seen at Kaiser Permanente facilities. Around here Blue Cross administers and audits the Medicare program.
So — lesson #1: you can have both private and public entities working together to provide healthcare.
As I mentioned before, in 1984 Medicare established a system of DRGs (diagnosis related groups) that are used in reimbursement. This system treats each type of inpatient care as a separate “product,” if you will, with different reimbursement rates for each product. It is a largely flat rate payment that is not based on what the hospital charges. This system gives hosptials a great incentive to provide care as efficiently as possible, and to have the best medical outcomes possible. This is because the flat payment does not reward inefficiency or bad outcomes. DRG-based reimbursement is now used by many Medicaid programs, and even by commercial insurers.
Lesson #2 – government can develop programs such as DRG-based reimbursement that can reduce healthcare costs.
These are just a couple of examples. Certainly government can do bad things as well and drive up costs through unnecessary or ill-conceived regulations. But that’s not the whole picture.
I don’t want to be insulting, but in this discussion you seem to me to be the anti-government version of a pacifist. The pacifist says that all war, anytime, anwhere, for any reason is wrong. War can never be good. There can never even be any good effects that outweigh the bad.
Likewise, it seems you think that governemt is always bad, always inefficient, always inferior to the private sector, populated by evil bureaucrats who, presumably unlike their sainted private-sector counterparts, are just out to increase their own power and paychecks. It’s really a caricature, not an accurate picture at all. It certainly is the picture that the right-wing think tanks want to portray, but anyone who has worked in government knows it isn’t true.
Note 71, Straw man, Jim
Jim, there is a big difference between arguing against a total nationalization of the health care system AND rejecting any role for government. For instance, both Dean and I have agreed that it is worth exploring the idea of government policies which facilitate competition and price comparison among insurance companies. Government does this in the NYSE and happens to do it very well. A government structure creates the stability and openness which allows a market to function very well, however, it is them market that promotes price competition and investment in American companies.
People are simply NOT rejecting all government policy when it comes to health care, I am arguing against total federalization. I am cautioning against heavy government involvement. No more than is necessary AND adults need to realize that we will never achieve perfection in this world. We may be able reduce the percentage of uninsured people below 16% (assuming that is a reasonable figure) but we will never achieve total perfection and attempts to do so are more damaging than the problem.
Note 71. Jim writes:
No insult taken. Just don’t assume my responses to Dean are responses to you as well. They aren’t. Dean advocates a total nationalization of health care. I don’t. Neither do you. I’ve never said government has no role. Generally I ignore charges like that because it’s just liberal boilerplate. Nobody takes it seriously. Missourian explained it well (the reasonable view) in note 72 so I won’t repeat it here.
“No apology was ever made. I would have been fine with the apology since mistakes inevitably happen. This just could have been an oversight. No apology though told me the problem was part of the hospital culture.”
The most important reason for this non-transparency of the bill and price is, you guessed it, government involvement. Hospitals do not cover costs of Medicaid (more and more an unfunded mandate as states are putting less and less into it) and Medicare patients. The government simply does not re-reimburse enough. So, who makes up the difference and provides a little profit to the hospital? You guessed it, the insured. So, next time you are considering the portion of your hard work that goes into Medicaid Medicare, consider that it is actually higher in that your insurance/co-pay’s are higher than they should be because you are making up the difference.
Still, this does not justify the non-transparency. Of course, a liberal approach to regulation would have worse effects than doing nothing…
Christopher writes: “The most important reason for this non-transparency of the bill and price is, you guessed it, government involvement.”
Some day Christopher is going to surprise all of us and find some problem where government isn’t the cause. We haven’t seen it yet, but it may come some day, and when it does, it may be a sign of the Second Coming.
Christopher: “Hospitals do not cover costs of Medicaid (more and more an unfunded mandate as states are putting less and less into it) and Medicare patients. The government simply does not re-reimburse enough.”
I know that Christopher doesn’t read any of my posts, but he should once in a while.
The first thing to note is that but for Medicad and Medicare, many of those patients would be uninsured, or “nonsponsored” in hospital jargon. Were that the case you would see three common negative effects:
1) people deferring preventive care because they can’t afford it, and thus developing more serious conditions that are more expensive to treat. Common and easily-treated conditions in this category include high blood pressure, high cholesterol, diabetes, urinary tract and other acute infections, and certain complications of pregnancy. Many of these conditions can be treated for literally pennies a day on the front end — or we can pay thousands or tens of thousands of dollars for more complex and critical care on the back end.
2) people showing up for treatment in the emergency room, which cannot provide adequate continuity of care, and which also is one of the most expensive ways to treat patients.
3) people dying earlier than they should have, or becoming disabled or unable to care for themselves.
Second, if Medicaid and Medicare paid more, then that would have the effect of costing more in tax dollars. From the point of view of a Christopher type of critique, government is damned if they do and damned if they don’t. If they pay anything at all, then that’s a bad thing, since that is not their role. If they don’t pay enough, then that’s bad too. Well, I don’t think you can have it both ways.
Third, Medicare reimbursement is typically not too bad. For inpatient care there is the standard DRG payment which is adjusted according to any identified complications or comorbidities. But the Medicare payment also includes a component for medical education and capital costs. In the event that a particular case goes very badly, there is also a cost outlier component. Some Medicaid programs also have these kinds of adjustments. It’s not a perfect system, but there is an attempt to have reimbursements that keep hospitals in business.
Fourth, under managed care, cost-shifting to commercial insurers is increasingly harder to do, especially when you get into DRG-based flat rate payments or per diem payments.
Christopher: “So, next time you are considering the portion of your hard work that goes into Medicaid Medicare, consider that it is actually higher in that your insurance/co-pay’s are higher than they should be because you are making up the difference.”
And also consider what the situation would be like without these programs.
Christopher: “Still, this does not justify the non-transparency. Of course, a liberal approach to regulation would have worse effects than doing nothing… ”
There should have been an apology, and most hospitals have a “patient advocate” or other similar position that takes care of such problems. On the other hand, a large hospital can generate several million transactions per year, and it is relatively expensive in time and resources to follow up on a single charge. Nonetheless, the hospital has an obligation to do that, especially when there is good reason to question the charge, and it is for a significant amount of money. Also, if the insurance payor in question bases reimbursement on a flat rate or fee schedule, then a bogus charge would have absolutely no effect on what the company paid. In that case, spending a lot of time auditing a patient bill would not be cost-effective for either the hospital or the insurer. I don’t know what kind of insurance Fr. Hans has, and thus do not know if the situation he mentioned falls into this category or not.
But what I find most interesting is Christopher’s parting shot: “Of course, a liberal approach to regulation would have worse effects than doing nothing…” I guess he has gotten to a point in life at which his contempt of “liberals” is so overwhelming that he just can’t help himself. He almost can’t discuss an issue without the obligatory “dig” at the liberals. He couldn’t bear to give the impression that a “liberal” might actually have a good idea. He fears that there may be some sinister liberal philosophy of hospital charge auditing. I suppose than when Christopher calls a plumber to unclog a plugged drain, that he has to question the guy to make sure that the plumber is not a liberal who is going to do some kind of liberal plumbing in his house. Christopher’s lawn service no doubt had to be examined to ensure that they were not going to mow his yard in a liberal manner. Yes, you never know what those liberals are up to.
Note 76, Dean now specializes in telling us that the good numbers mean nothing.
Note that Dean’s new economic cause is to refute the idea that:
Dean has to argue that all of these economic indicators, the very economic indicators that have always been used to measure the success or failure of an administrations policies are no long relevant, they are to be ignored. If George Bush single-handedly pulled an elderly lady out from in front of a speeding bus, Dean would find a way to point out that the elderly lady suffered a wrenched wrist in the process and that, therefore, Bush should not be given any credit.
Anybody remember Jimmah Carter? Does anyone remember the 9% unemployment and 10% inflation that that pompous incompetent left us with? Were those numbers irrelevant? Did they represent any real economic pain?
You betcha, I remember being a young graduate trying to find a job and those were hard times.
Note 76, Be suspicious of anyone who calls fellow Americans “the masses”
Dean quotes an “economic writer” who referse to Americans as “the masses.”
Is it just me or does the use of the term “the masses” to refer to fellow Americans grate just slightly on the ears. I don’t think of my fellow Americans as undifferentiated “masses.” Masses might, and I say only might, be suitable for uneducated 19th century peasants, but not Americans. Americans are individuals and they don’t “mass” well.
Where, one asks, does the term “masses” come from? It is the term used by Marxist theorists to refer to the 98% of humanity which the Marxist boss believes should have their lives run by the self-same Marxist bosses.
The choice of the word is telling.
Note 78. Missourian writes:
Absolutely correct Missourian. The word indicates a frame of mind where people are herded into categories, intellectual at first, literal later — like Gulags and concentration camps. Does this sound alarmist? Only to those who don’t understand how thinking informs action.
BTW, a small correction. “Masses” does not work for nineteenth (or even twentieth) century peasants either. Solzhenitsyn proved this when he would quote the wisdom of the peasants towards their Communist oppressors in the last century.
There have never been, nor will there ever be “masses” in the sense of this context. Once again we return to the question Dean has never answered. Who does he think man is?
There is no religious subtext in Mr. Gross’s use of the word masses. He simply uses the word to refer to that portion of the population not among the extremely wealthy one percent who have been the primary beneficiaries of Republican economic policies. There is no hidden secular humanist agenda.
But pretending there is a religious subtext does provide a way to sidestep and evade the central argument in Mr. Gross’s rebuttal of George Will. First, the Dow Jones Industrial Average is comprised of a narrow slice of all stocks traded in the stock market. Indexes comprised of a broader and more representative sample of stocks, such as the S&P 500, remain below the highs they set in 2000. Second, the current Dow Jones Average is at a high only in nominal terms – that is when not adjusted for inflation. In real terms – adjusted for inflation – the Dow remains below it’s 2000 high.
So the truth is that after six years of Republican economic leadership, the stock market, a leading indicator of economic performance, has barely moved above the level it was at before Mr. Bush became President, and then only in one narrow index, unadjusted for inflation.
Missourian notes the following indicators of successful economic management.
1) good unemployment numbers
2) low inflation
3) high stock market performance
4) Decreasing deficits.
Lets scrutinize these more closely.
Good unemployment numbers: These do not reflect the numbers of people who have dropped out of the job market and stopped looking for work. Nor do these reflect the types of jobs that are available. Stagnant wages may suggest that high-paying jobs, especialy in manufacturing, are being lost and replaced by low-wage service sector jobs.
Low inflation: Prices have remained low, on average, however the price of many major purchasing items impacting the middle class have increased and become more prohibitive, namely health care and college tuition. Gasoline and fuel prices remain volatile and subject to bad weather or middle-east news. It should be rembered that deflation is not a desirable economic development either, and that too steep a fall in home prices may have a negative impact onthe economy as well.
High stock market performance: see paragraphs 1 – 4.
Decreasing deficits: The annual federal budget deficit is still far above that level that existed in 2000, the year before a Republican occupied the White House. In fact, in 2000 there was no deficit, the federal budget had a modest surplus. It should be noted that the current deficit figure is several hundred billion dollars higher than reported if borrowing from the Social Security Trust Fund is also included.
Note 81, “Toiling masses” enjoy increased wages/benefits. Dems cower, weep, gnash teeth
“Toiling masses” enjoy increases in wages and benefits.
Maybe this will stem the tragic flow of bitter American workers leaving the country looking for economic opportunity in Europe. f.
Query to Dean. Do you think living in an economy such as the EU which has been stagnant for 10 years is good? “Stagnant” is defined a 0% growth. Do you think massive unemployment of young workers is good? “Young” being defined as 18-35? In Europe a few cosseted government workers and unionized workers have all the benefits and protections from competition while high percentages of young and poorly educated workers have no hope.
The union motto is “I’m alright Jack.” Union workers “have theirs” and they don’t really care about people trying to enter the world of work and get some experience or other who may be considered “marginal” employees. Union members don’t care about low-skilled workers because unions drive the cost of labor up which decreases the number of jobs and promotes the replacement of workers with technology.
http://www.breitbart.com/news/2006/10/31/D8L3MD380.html
Wages, Benefits Up at 2-Year Best Pace
Oct 31 10:06 AM US/Eastern
By MARTIN CRUTSINGER
AP Economics Writer
WASHINGTON
Wages and benefits paid to American workers rose in the July-September period at the fastest pace in more than two years.
The Labor Department reported that its Employment Cost Index was up 1 percent in the third quarter, compared to a 0.9 percent rise in the April-June period. It was the biggest quarterly increase since a similar 1 percent rise in the second quarter of 2004.
The increase, which was above the 0.9 percent rise that economists had been expecting, was led by a big jump in the cost of employee benefits such as health insurance and pensions.
For the third quarter, benefit costs rose by 1.1 percent, up from a 0.8 percent gain in the second quarter. Wages and salaries were up 0.9 percent, matching the increase in the second quarter.
Officials at the Federal Reserve are watching closely to see whether wage pressures are beginning to accelerate, a development that would give workers’ more money in their paychecks but could fuel unwanted inflation.
The Fed is hoping that its two-year campaign to slow the economy by raising interest rates will do the trick to send underlying inflation rates lower without slowing growth so much that the economy topples into a recession.
The government reported last week that the overall economy grew at a lackluster annual rate of just 1.6 percent in the July-September period, the slowest pace in three years, reflecting a sharp fall in the once-booming housing industry.
Analysts believe the recent sharp decline in the cost of gasoline and other energy products will give consumers more money to spend on other items and provide a boost to the economy in the final three months of this year.
The Fed, after raising interest rates for 17 consecutive times, has left rates unchanged since August with financial markets hoping that inflation pressures will slow enough to keep the central bank on the sidelines for an extended period.
There are indications that the Fed’s battle against inflation is having an impact. The government reported Monday that the Fed’s preferred measure of inflation, which excludes energy and food, rose by 2.4 percent over the 12 months ending in September, down slightly from a 2.5 percent rise for the 12 months ending in August.
Even with the slight decline, inflation is still above the Fed’s comfort zone of 1 percent to 2 percent, which is why analysts believe the Fed will not respond to the slowing economy with rate cuts until inflation declines to a more acceptable level.
For the 12 months ending in September, overall compensation costs were up 3.3 percent, compared to a 3 percent rise for the 12 months ending in September 2005.
Wages and salaries are up 3.2 percent over the past year, a significant rise from the 2.3 percent gain for the 12 months ending in September 2005. Benefit costs, however, were up 3.3 percent for the year, down from a 5 percent rise for the year ending in September 2005.
Note 81. Dean writes:
Not religious Dean, but ideological. Missourian is correct. The term is very revealing because only neo-Marxists, collectivist, socialist — what ever you want to call them, use it. Maybe it was a slip of the tongue, but it is not a slip anyone with any credibility in economics would make.
Given the authority you project in your discrediting of Will, I am surprised you weren’t aware the term is ideological in nature. It is part of the standard neo-Marxist (economical and cultural) lexicon. I will however, agree with your point albeit inadvertently made that the Marxist praxis (including its Progressive variant) functions as a religion — secularized Messianism actually.
The question to me is not religious in nature, nor ideological, nor political. My question is founded on the premise that in order to have a working idea of society, one has to have a truthful understanding of the nature of man, a correct anthropology. One’s anthropologial understanding directly effects one’s religious life, ideology and politics. There are spiritual anthropologies, materialistic anthropologies, anthropologies that postulate man solely as an individual and ones are the reverse of that in which man is merely the creature of the greater whole. There are a variety of Christian anthropologies one of which is specifically Orthodox. It only seems reasonable for you, Dean, to specifically explicate your own anthropology as it will throw great light on the way you approach all social issues and enable a far better dialog.
I think it is pretty easy to intuit my anthropological approach for one, who like you, has been reading my posts for quite a while now, but I’ve never really been able to understand yours.
Note 70, Fr. Jacobse, I stand corrected
You are correct and I apologize about my use of the term “masses.” That term always struck me as dehumanizing anyway. It wipes away people’s individuality and uniqueness.