Epiphanyblog

All about ideas…

Conservative Health Ideology is Still Wrong…..

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Budget Cuts in 2011 Sign

I object to many of the points in this article published by the American Conservative Magazine…and many of its comments.

According to PEW, I’m a liberal. However, I do not believe in taxing hospitals and providers at extraordinarily (75%!) high levels as the American Conservative article claims all liberals want. Nor do I believe in making all doctors/practitioners state workers. I find these notions shocking and antithetical to our democratic principles. In addition, I do not agree that liberals want someone else to pay for our health care needs. All of my liberal, Democratic friends agree with me on these points. Conservative talking points about what liberals and Democrats is long out of date, thus making them no longer relevant.

I agree that more money should and could be put into health cure research. Curing diseases, as in eliminating them, does bring down cost of health care. However, contrary to what some people posted in the comments section, the fed government via the NIH has provided much of the needed funding for basic research. Health care companies, in general, have reduced their R&D budgets by billions as more me-too drugs and generics hit the market which means the NIH grants become all the more important. I realize this flies in the face of the oxymoronic notion that government cannot do anything right. Would those thinking this way say the same about the DoD and DARPA over the last 30-plus years? Tremendous research is being carried out all across the country by leading research labs and universities as a result of NIH and allied federal research institutes’ funding.

Third, regarding costs. When people talk about how much cheaper it was to get medical care back in the ’50s they fail to note how much medical care has changed since the ’50s. Technologically driven advances drove much of the increased costs. Comparing 1950s medicine to today is like comparing the Model T to today’s automobile. Ain’t gonna work! It’s why a comparison of the 1950s costs to today are totally worthless at best and deceptively ignorant at worst. By the way, health insurance was instituted by companies, as an employee recruitment draw, during WWII. You know, back in the early ‘40s. So, the ‘50s argument about costs is ludicrous on its face as most large companies already offered health insurance to their employees.

The author correctly states in his analysis that hospitals shift cost losses from ERs to all other areas of the hospital. If hospitals failed to do so, they’d go broke rapidly since EMTLA (since Reagan signed the law, hospitals cannot deny treatment to anyone without insurance, regardless of ability to pay cash) is the law for the land. Thus, ERs have become loss leaders even while being necessary as public/community services. But the medical establishment, in conjunction with politicians, has divided up hospital territories upon which, all too often, none shall intervene.

But more to the point is that medical costs are opaque. Even when you ask about costs, most of the time you cannot get an answer. Either the provider refuses to give an answer or says that different insurance negotiating policies provide different pricing so they cannot/will not provide you an answer regarding pricing. In Taiwan, which has a single payer system and a private practitioner system, all prices of all the different providers are printed and posted in every provider’s office so patients can see the prices and can make their decisions accordingly. We don’t have that same transparency here in the US. How can you know you’re getting the best bang for the buck if pricing and comparative quality remain a mystery?

In addition, regardless of emergency needs, how many of us are capable of telling our doctors, “Sorry, I don’t want to do that test you demand I take or take that expensive medicine you prescribe”? Medical care is not like buying shoes or cars, regardless of the libertarian arguments simply because health care consumers – patients – understand they are not medical experts. If the doctor says do x, y, and z, we tend to do it because we believe the doctor is the expert and knows best. And all too often, as I’ve discovered, when you argue with the doctor, he angrily pulls the argument that he’s the professional and you’re not…do it or else! Free financial markets, to work correctly, depend upon access by all to the same information. That doesn’t occur all too often, and most particularly does not occur in the health care market because we’re not all equal experts in health care.

In addition, current regulations preclude the ability of Medicare from negotiating RX prices which means this country subsidizes other countries. We in the US essentially pay higher costs so those other countries can obtain lower prices. As a free market advocate, I object to that subsidy to other countries.

Finally, let me say that I and my liberal friends look forward to the day when health insurance is completely separated from the current employer based system to one that enables a group of like minded individuals to buy insurance on an exchange at market competitive prices. We recognize, as realists, that health insurance is not going away…it’s been around too long and has a huge hold in the mindset of too many people as an appropriate way to spread costs a la all other insurance policies. In addition, many of us liberals hope that once the exchanges are up and working well, a la Reihan Salam, that Medicaid, Medicare and VA outpatient systems can be moved into that singular system similar to Switzerland which spends approximately 11% compared to our almost 18% (17.9% in 2012). Currently, our health care systems are so fragmented that the most needy in those systems cause the highest cost. Moving everyone into the same system spreads the cost across a greater market – which the rest of the insurance market essentially does – to decrease costs for any individual or family.

Further, it should be noted that PPACA, aka Obamacare, does go a long way to fund pilot projects that looks at other health care funding models. Some 27 provisions in the PPACA legislation provide state approved or organizationally approved experimental models. The goal of these 27 provisions is to determine what works to provide the best heath outcomes at the best prices. Many of them are showing such remarkable results that large private companies like Boeing have signed up for.

For the libertarians out there, might I remind you of two things: 1) Friedrich Hayek said he was not a conservative because conservatives look to the past while he looked to the future, and, second, that he believed it was necessary and vital to provide a strong social safety net, including national health care, as societal goods because they promoted social and political stability.

What I believe most conservatives, including many social scientists like Prof. Heidt who claims to lean liberal, get wrong is that modern, post-Clinton Democrats are not adverse to capitalism but rather see the difference between laissez-faire capitalism which never worked for the masses (see Adam Smith, the Irish Famine & British Parliamentary history, early 1900s in the US, Robber Barons, Progressive Movement, TR’s autobiography) and long held Jeffersonian – Jacksonian values of opportunity regardless of the social and economic class into which one was born and regardless of race or ethnicity or wealth. What we liberals don’t demand is equality of outcomes, but rather equity of beginnings, i.e. education.

As a result of our modern belief system, liberals want a medical care delivery system that is fair to all providers while using the best technology and gathered data available to lower delivery system costs including using data from other OECD countries.

Rather than being ideological, we seek pragmatic answers to our modern challenges. Can today’s GOP and its libertarian allies say the same?

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