Sunday, July 1, 2012
Sunday Question for Conservatives
Mitch McConnelll is getting plenty of grief from liberals today for saying that Americans without heath insurance getting covered is "not the issue." What do you think? Should conservatives care (in a policy way, that is) about getting to universal coverage, or should the government be neutral about it?
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Of course McConnell is right - the weird liberal conflation of healthcare with health insurance is none of our business. McConnell and Romney have both rightly said that the important thing is that healthcare is cheap and widely available, and have set out free-market measures to achieve that. That is the key issue - the uninsured don't want to be insured at current prices - otherwise they'd be insured! Let the left waste their time on this phony issue, which when you dig into it is just another attempt to steal from the makers and give to the takers. Obviously we must take no part in that.
ReplyDeleteHow can you justify saying this when Romneycare = Obamacare
DeleteSpoken like someone who is, most likely, like absolutely every person in this country who does have adequate access to care, one way or another, getting his health care subsidized by other people.
DeleteAs a business owner responsible for providing for my own health care coverage and that of employees, I can assure you that neither health care nor coverage is cheap or, for those whose care and coverage isn't being subsidized by employers and government, easily available -- nor is there a Republican proposal on the table that will or can make it so.
Bottom line; you can't have a modern, effective health care system without some form of socialization (that is, some form of cost sharting, some method by which the whole and well are responsible for ensuring and supporting care of the ill and dying). The cost of maintaining such a system is simply too much to be borne by individuals alone, that is; the ill and dying themselves.
Conservatives who resent being responsible for the cost of care for "other people" aren't speaking in support of "free market" ideology -- they are railing against reality.
It's true that in the romanticized, that they mistakenly presume to have been more libertarian past, physicians could, as one Republican Senatorial candidate gushed in 2010, on occasion be paid "in chickens." But that physician couldn't do much for his patients anyway, so it was a pretty fair trade.
Where health care is involved you have special expertise on the selling side of the equation and (potentially) death on the buying side. So it's not an ideal arena for "free market" solutions. We aren't talking widgets here.
ReplyDeleteBuying across state lines is not a "free market" solution. It's a race to the bottom and an affront to federalism. What other free market solutions are the Republicans holding?
This comment was meant as a reply to Anonymous.
DeletePlus, health care is different because people w/o insurance will not be turned away from an emergency room.
DeleteJust let people buy the health insurance they want. It costs nothing but the forbearance of those who suffer from a passion to control their fellow citizens.
DeleteCouves, you understand nothing about the healthcare market.
DeleteOf coarse we who can not aford either forms of socilized health care tend to believe that the way we spend what little EARNED income we have should be by our own right controled by us. To be forced to live according to another's standard based on an assumed right is Socilistic BS. "I would rather make the gravest of mistakes, than to surrender my own judgement"
DeleteI think the 30 million uninsured matter a lot. Contra the recent CNN gaffe thread, I believe the mandate is the central feature of the ACA. Not just because those 30 million can't access insurance, but rather because so many won't. For many of those 30 million, Couves/McConnell's diagnosis is correct, the insurance options are there. Why don't people buy it?
ReplyDeleteNot sure about the numbers, but some (typically young) folks are in the place where new-father Jack Osborne probably was two weeks ago: not planning for a multimillion dollar, multi-decade fight against MS. Many folks don't buy health insurance for the same reason they don't buy life insurance: they don't like to think about the implications. In addition, in America, it may seem to the uninsured like the ER, with its many wonders, will cover you if something happens.
(As an aside, Obama was against the mandate before he was for it. His initial rationale was that everyone would buy health insurance if they could only afford it. Obama apparently lacked an instinctive understanding that some - many - folks would avoid insurance due to the unpleasant externalities - in addition to the opportunity for free-riding.
This is odd because Obama is arguably history's greatest beneficiary of progressive policies breaking through the old boy network; that was arguably true even before he became President. The greatest champion of that movement, MLK, famously died intestate, even though he knew probably as well as any otherwise-healthy thirtysomething that his days were numbered. Somehow, this notorious detail of MLK's narrative made little if any impression on Obama).
Not sure how much the mandate will help, but I am optimistic that forcing people into the health insurance marketplace will be a big positive for forcing changes like price transparency, consumer empowerment, etc, that conservative-types love. I do hope so.
@CSH -- that was always a campaign-trail lie because he didn't have enough policy differences from Clinton to tout and -- as is now quite clear -- "the other candidate will FORCE you to ..." is always a winner.
DeleteAs for people without health insurance: the insurance may be there, but it's not an option for most people who don't have it. Look at this data about the people who are uninsured in Massachusetts post-reform:
http://theincidentaleconomist.com/wordpress/who-will-be-uninsured-in-the-future/
These are the hard core of the uninsured. It excludes the vast number who pre-reform couldn't get health insurance because of preexisting conditions, which constitutes a very large chunk of the uninsured in America as a whole. The people who, even with a mandate and subsidies in place, even when preexisting conditions no longer form an absolute barrier, still aren't buying health insurance. Yes, they're more likely than the general population to be young, single, and male. They're also more likely not to speak English well or have another family member who does, less likely to have gotten anything like a standard education, more likely to have low incomes, and more likely to report serious "financial stress," which I take it means -- more likely to have little or no accumulated wealth. They're also, hold your breath, more likely to belong to racial and ethnic minorities. The "young singles who feel invincible" form a tiny, tiny, tiny portion of the uninsured. Even among my privileged private-school-educated twentysomething friends, the ones who go without health insurance are the ones who can't get a job that will offer them insurance. A couple of friends have worked full time for long (more than a year) periods at big companies who have no health insurance or thank their stars they're married to someone who does. Why? Because they were hired as "consultants," with short contracts, lower pay, no job security, and no benefits. One of these friends ended up quitting her job and moving across the country to start in a new field because she was so worried about her lack of health insurance. I have no doubt that there are a few people who shrug and say "I can pay full price." But the vast, vast majority of people without health insurance don't have health insurance because they either have no way of getting health insurance or are not even aware that they could get and would benefit from having health insurance.
(A quick thought should show this anyway -- something more than fifteen percent of Americans were uninsured for all of the most recent year surveyed -- around fifty million people. Some millions of them are children, but even so the rest couldn't possibly consist mainly of young people who feel invincible.)
Obama is arguably the one president in my lifetime that has done more to destroy our constitutional rights than any other. As for being unwilling to buy insurance, consider the fact that most items used in healthcare can be produced and sold for a fraction of the going rate. The technology can be developed and marketed without the hype of that industry and the hospitals can be run localy far cheaper than the big corporations now involved. As a moral point I refuse to support a system that abuses the ability to serve and turns it into a profit margin that is geared towards making me pay for healthcare "services" priced at 200% (or more) profit.
DeleteOn the other hand if we as christians believe in assisting others, then by all means support your LOCAL healthcare industry. Also known as put your words into action and stop expecting the "system" to fix your unwillingness to take real responsibility.
@theclassicist, I take your point, I used the weasel word "many" in my post since it conveys the impression of "a lot" but could, in a pinch, defensibly mean "fifteen". I just don't know much about the demographics of health insurance avoiders.
ReplyDeleteCaveats aside, I wouldn't expect the private school set to be a problem in carrying health insurance. I would expect the following to be true for 95% of them, all but the very richest and poorest private school families:
1) Rich enough to be able to contract for some sort of private health insurance (including moving to a friendlier jurisdiction, if absolutely necessary).
2) Not so loaded that a long-term, chronic ailment wouldn't lead to financial ruin if uninsured.
Due to this combination, I would expect substantially everyone in the private school niche to seek health insurance if it isn't provided passively. Its the secretaries and others who make little (and have little) that are a concern.
Speaking of which, thanks but no thanks for the blog post about the uninsured. After my dumping rant last weekend, I needed that like a junkie needs a hit. In case anyone followed the classicist's link, yeah the secretary at GE making $46 K/year (just above 4X poverty) will be paying $10 K - $16 K per year for health care in the exchange under the ACA. And...er...dropping that subsidy will cost GE $2 K. And...ahem...that secretary won't be able to afford that. My goodness!
(BTW - one of Jonathan's pushbacks against my rant last weekend was that surveys are notoriously unreliable. Certainly true. However, the McKinsey survey in question was taken in spring of 2011 - presumably employers are much smarter now about their health care choices than they were then. So McKinsey's alarming forecast of 60% dumping may indeed be way way off. Could be way too high.
Then again - buckle your seatbelts - maybe its way too low.)