Why Obama Will Win. Part 1
John McCain’s website on the number one or two (depending on your poll) issue troubling Americans:
Families should be in charge of their health care dollars and have more control over their care. We can improve health and spend less, while promoting competition on the cost and quality of care, taking better care of our citizens with chronic illness, and promoting prevention that will keep millions of others from ever developing deadly and debilitating disease.
Um. What? Does that mean anything to you? How about this:
Make patients the center of care and give them a larger role in both prevention and care, putting more decisions and responsibility in their hands.
And that means what, exactly? Anyone? How about:
We must do more to take care of ourselves to prevent chronic diseases when possible, and do more to adhere to treatment after we are diagnosed with an illness.
Childhood obesity, diabetes and high blood pressure are all on the rise. We must again teach our children about health, nutrition and exercise – vital life information.
Public health initiatives must be undertaken with all our citizens to stem the growing epidemic of obesity and diabetes, and to deter smoking.
So the federal government’s going after fat kids? The federal government’s going to make sure you take your pills? The Republicans will foster a nanny state attack on lifestyle issues like smoking? Everyone who believes that, raise your hand. What? No one?
Support innovative delivery systems, such as clinics in retail outlets and other ways that provide greater market flexibility in permitting appropriate roles for nurse practitioners, nurses, and doctors.Where cost-effective, employ telemedicine, and community and mental health clinics in areas where services and providers are limited.
And in what way do either of those have to do with the federal government? Is the federal government outlawing clinics in malls? I must have missed that. Kinda think that’s all at the state and local level.
Protect the health care consumer through vigorous enforcement of federal protections against collusion, unfair business actions, and deceptive consumer practices.
Yes, because when you think “vigorous enforcement” of regulations on industry, you think GOP.I’m being a little unfair. There are one or two substantive suggestions. Here’s the one a Republican would actually try to pass:
Pass tort reform to eliminate frivolous lawsuits and excessive damage awards. Provide a safe harbor for doctors that follow clinical guidelines and adhere to patient safety protocols.
In other words, if your doctor kills you, he shouldn’t have to worry about being sued.Here’s my personal favorite:
Promote competition throughout the health care system – between providers and among alternative treatments.
Exsqueeze me? Alternative treatments? Are we talking crystals here?
Read McCain on health care and health insurance and you get bromides and bullshit, with the only honest portions having to do with more tax cuts to help people who don’t particularly need the help, and of course protection for incompetent doctors.
Here’s a portion of the health care section on the Obama site:
Obama will make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress.
The Obama plan will have the following features:Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions.
Affordable premiums, co-pays and deductibles.
Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.
Whether you like the McCain approach, or the Obama approach, I think it’s hard to dispute the fact that McCain’s high-school-kid-stretching-to-reach-a-thousand-words-for-the-term-paper approach to health care is at least 90% straight-talk-free. It means, in effect, nothing. Nothing substantive will be done to deal with this most pressing of issues. If you’re one of those people having a hard time keeping up on your medical bills, worried you’ll lose your insurance, McCain isn’t too reassuring, is he? Especially in a shaky economy?
You may not like Obama’s approach, but it is something. It is not nothing. It is a change. It is not the same old same old. If you’re worried about going bankrupt when your kid gets asthma, or your wife gets breast cancer, or you suffer a stroke, Obama has an actual, substantive solution. Whereas McCain limits his reassurance to doctors.
So, Obama is the “empty suit” and McCain’s the serious thinker. Yeah?
Let’s put the respective plans before middle class, $60,000 a year, working families in Pennyslvania, Ohio and Florida. (Just to pick three, um, random states.) Who do you think they’ll consider the more serious, substantive candidate? Which plan do you think they’ll like better? The one where they are allowed to save some tax free money they don’t have, in a special savings account that’s already available, so that they can use the 3 or 4 grand they might manage to scrape together over a decade of scrimping, to marginally slow their descent into medically-induced bankruptcy? Or the one where no matter what happens, their kids get in to a see a doctor?
McCain supporters need to realize something: it’s not 1993 anymore. Harry and Louise and hysterical accusations about socialized medicine aren’t going to work this time around. Fifteen years have passed, and we’ve had medical savings accounts, and we’ve had 8 years of GOP dominance, and guess what? People areless likely to have adequate health insurance now than they did then. Obama proposes, in effect, extending the Congressional system to regular Americans. Let’s hear John McCain explain why it’s good for him and the millionaires in Congress, but wouldn’t be good for a working mother in New Jersey.
McCain on health care? Empty rhetoric. Obama on health care? An actual plan. An actual plan that actual people can actually understand.
Even if the Dems are currently winning the argument and convincing people that the government should take over our healthcare system, it doesn’t mean they’re correct that this is the right solution. You could be correct about this being an issue that skews the election toward Obama, but many of us realize that the govt can’t wave a magic wand and make it affordable for every citizen to receive every treatment necessary. We don’t need scare tactic ads to convince of us of what is an obvious truth: there’s no such thing as a free lunch or a free healthcare plan.
Health insurance for my family of 4 costs 12,000 a year. With no certainty that they won’t pull the plug on me and leave me uninsured. So the question for me is whether it would cost significantly more than 12 grand a year if I switched the payments from my current insurer to whoever manages the Congressional plan. If at the end of the day (or billing cycle) I’m not paying much more, but getting more security, I’m for it.
I see no reason to believe that a new national healthcare plan could offer the same benefits to ALL Americans that are currently available to federal employees without a whole host of problems that result from the expansion of scale of the project. It’s like assuming that your local neighborhood family run restaurant is so well run (imagine a place where a couple of generations have run a top notch place where you know you can always get a good meal and great service at a decent price) will be able to expand to a nationwide franchise serving hundreds of millions of people, without a hitch.
Christine, it’s obvious that the scale of a system offers challenges in implementation. It’s also obvious that some people will want better than the level of care government can pay for. What people must remember is that if you can afford better, you’re free to get better medical care.
What is true is that it implies raising taxes, an unholy spectre that seems like the worst thing that could possibly happen in US politics. It’s laughable considering that US taxes are rather low on the world standard. I simply don’t see the problem with paying some more taxes considering that you won’t have to be paying private premiums. Of course people will always object to paying taxes to fund things they don’t need, but I see no argument against publicly funded health care that couldn’t be used equally against public schooling. After all, why should I pay taxes for public schools if I send my kids to private school, or if I don’t have children? Why is 100% privatization great for health care but not for schooling? W
Claudia, I offered that analogy in the context of Michael Reynolds assuming that an alternative national plan offered by Obama is going to be preferable to his current coverage.
The broader arguments against Obama’s plan were covered well by the CATO institute- for example, his plan would move further toward tying insurance to employment rather than the other direction which makes more sense; his plan would force employers to pay into the nationalized system, which in the end only means lower wages for the workers. And, his idea for an ‘Exchange’ would reduce the amount of choices to consumers, just as it did when Romney implemented basically the same thing in MA.
Basically what I’m trying to say is that we’ve unfortunately reached the point in the national dialogue when citizens throw up their hands and say, "I’ll vote for the guy who says he’s going to do SOMETHING, without really considering whether that something is going to result in a net gain without unintended consequence that do more harm than good." That’s when I, as a conservative, get very worried.
As to your question about education, it makes no sense to me to say that since we have a public system of education, we must assume that it would be equally beneficial to provide public healthcare for all. Why not keep going with that argument? Why not public housing for all, and govt distribution of food for all? Those are all ‘needs’, so why aren’t you arguing for the govt to provide them? Besides, you and I have discussed this before and I’ve already explained that I think the public education system works because the needs are more narrowly defined (K-12 education) and finite, whereas healthcare is too broad (everything from prenatal to end of life care, with great difficulty in drawing lines on what is essential vs. nonessential) and constantly morphing into a larger and larger need as we redefine standards with each biomedical and technological advance.
Claudia, public schools are hardly a good argument, these days, for government-run anything.
Beyond that, there’s some big differences between education and healthcare. We all benefit from providing education to the youth, whether we have any ourselves or not. We would all be worse off if we grew old in a country with large numbers of uneducated idiots running around. While some public subsidy for healthcare for the poor helps all of us (reducing the number of communicable diseases, keeping more folks in the workforce, etc.), it is much more of a "private good" than is education. The case for providing it universally to all is not as compelling for that reason.
Schooling is also a poor analogy because there’s a relatively limited demand for it. There are only X number of school-aged kids at any given time, and there are only about 8 to 10 hours available in any given day to provide education. With healthcare, the demand, particularly given our constant technological improvements, grows very large, very quickly, once you make it available at little direct cost to the consumer.
Can some people pay more for "better" care? Well, that depends on several factors. One, some nationalized systems of healthcare don’t, in fact, allow for private doctors and private hospitals. But let’s look back at your education example. There are plenty of people out there who would pay an extra, say, $100 per month to improve the quality of their child’s education. But they can’t do that. They’ve already paid $4,000 or $5,000 towards education via their taxes already, but they can’t add their $100 to that pot and then pay for private school tuition with the combined total. For many people, because they’ve already paid so much in taxes, they can’t afford to pay the entire cost of schooling a second time. With healthcare, you could wind up with the same problem. If you buy private insurance, or private care directly from a doctor, will the government program kick in its share, so you only have to pay the difference between the government rate and the higher rate for better care? Or will you be responsible for paying 100% of the private care’s costs, essentially getting no personal benefit for the fortune in taxes you’ve paid?
LOL, Pat, I have to laugh at your first paragraph because as I was writing my comment I was thinking to myself, "why in the world would we want to duplicate the disaster of federalization of public education, where every time we pour more money in we end up with worse results?"
And your last paragraph puts into words something else that was running through my head. Claudia, you seem to be saying that those of us who would choose to keep our own private plans shouldn’t be concerned about a proposal like Obama’s to offer this alternative national plan, because we can just keep on with our current plans without consequence. Well, except for the fact that we then have to pay for Michael to have the plan he chooses and continue to pay for the plan that we choose- and of course for some people, that won’t be possible so they will in fact be limited to the choice of accepting the national plan. And that’s not to even mention the fact that the costs for everyone end up going up because increased usage of healthcare services without a concommitant increase in supply of the services leads to an obvious increase in cost.
Pat, I’m afraid that I don’t buy the argument that a more educated populace is better for all of us, but a healthier populace isn’t.
Again, I don’t see that much of a difference between both kinds of issues. Education is limited and health care isn’t? Well, that’s not quite true is it? PUBLIC education is limited to K-12, but if you can pay for it, you can educate yourself until you’re 100. Likewise public health care can be limited in it’s scope. The fact that it COULD be amplified infinitely does not mean it WILL. If that were true every European country would have already collapsed (funny how no one remembers that public health care already exists, and WORKS in places that aren’t Cuba).
Last I checked people with money still send their kids to private schools, despite taxes. People with money in Europe go to private doctors, they are not in trouble. In fact, you could ask middle class folks in pretty much any European country whether they’d like to eliminate universal health care, take those tax euros and spend it themselves on an American-style program. The look on their face would be amusing, at least.
Why not eliminate all public schooling so people can use that tax break for a private school? Sure a certain precentage of kids will never learn to read or write, but that’s just life isn’t it? I simply cannot wrap my mind around the idea that someone being unable to read or write because they couldn’t afford schooling is unacceptable, while someone dying because they couldn’t afford chemotherapy or losing their house because their kid has a chronic illness is acceptable.
I’m choking over that one, Claudia. The plan being put forth by Obama is for everyone in the US to have access to the healthcare plan that is available to federal workers- which is LESS limited in scope than many of our current private plans are.
So where are the limits going to come into play? Oh, yeah, that’ll happen down the road when it becomes painfully obvious that this approach costs way more than the estimates showed, and that the cost savings that were supposed to happen don’t materialize. But by then it’ll be impossible to set any reasonable limits because voters won’t voluntarily give up what they’ve been promised. So the cuts will come in ways that at first aren’t so obvious to consumers (but eventually people will notice that they don’t have the same choice of drugs or treatment options, or that the waiting lists for MRIs and elective surgeries are getting awfully long…)
And as for the argument that ‘it works in Europe’, first show me a single country as large as the US that has universal coverage, and second, tell me where the money for innovation is going to come from (currently the US subsidizes this for the rest of the world.)
Only people with LOTS of money can send their kids to private school. Most middle class families either cannot afford to do so, or must sacrifice A LOT to do it. That’s because they are paying twice, once for everybody else’s kids to receive a crappy education (in some areas) and once for their own kid to receive a decent one.
As for your last point, you’re reading FAR too much into what you think the other side is saying. You may have noticed where I mentioned in my last comment that it was appropriate to provide some subsidy of some sort to help the poor to obtain healthcare. One can, in fact, make sure that the dying can get chemotherapy without creating a universal, single-payer model for healthcare.
As for a "healthier" populace in general, personally I think we’d get more bang for our buck by requiring everybody to go to the gym 3 times a week and cut back on unhealthy eating. A LOT of our health costs today are dedicated towards fixing the consequences of unhealthy living habits. I’m not sure why I should subsidize paying for Lipitor to lower the cholesterol of somebody who continues to eat fried chicken regularly and watches 5 hours of TV every night.
BTW, Claudia, when you say that healthcare coverage COULD be limited in the same way that public education is limited, I agree. The problem is that none of the candidates is proposing anything like that. One way it could be done is to provide vouchers for the working poor so that they can have access to preventative healthcare instead of burdening the system with visits to the ER and care for chronic illnesses. I wouldn’t oppose a reasonable form of that at all (by reasonable I mean that it would also be important to work toward increasing supply end of routine, preventative care medical services)- but again, this is much, much different than what either Dem candidate is currently proposing.
Oh, and you might want to do some more research on private care in countries with nationalized healthcare. Some are much more friendly to private doctors than others. England has had significant caps and limits on the amount of healthcare which can be sought from the private sector.
Pat:Maybe we could emulate the better as opposed to the worse systems. Maybe we could model on the French system whose people outlive ours by an average of 2.6 years despite the fact that they smoke quite a few more cigarettes than we do. The French pay a fraction of what we pay and seem quite happy with their service. We really need to get past this absurd jingoistic nonsense that we have the best medical care in the world. We don’t. A sick American is often a bankrupt American. A sick Frenchman only has to deal with the disease, he doesn’t also have to beg for his life from a health insurer and scramble to keep his children from going hungry.
One problem is that a government-provided system cannot, almost by definition, implement limits. Why? Because they are inherently "discriminatory" and that is not allowed.
Incidentally, the same is true in public education in that schools are not allowed to "discriminate" against, er, "less gifted" students by grouping children together based on their abilities. This naturally leads to a decline in the education delivered to the more-gifted students; however, this is not viewed as being important by the P.C. crowd. This systemic inability to deliver high-quality education to those who need – dare I say deserve? – it most is perhaps the most shameful failure in an altogether mediocre system.
Am I really to expect better from a government-run health care system given that the field is infinitely more complex than childhood education?
Michael, do you have any research at all to suggest that the French live longer than us because of access to medical care, as opposed to because of lifestyle advantages? They walk more often and longer than we do, they eat better (despite the smoking), they have a healthy glass of red wine more often than most Americans. I’m not aware of any general research showing that average life-span is a good measurement of the quality of healthcare in a country.
As I’ve noted many times elsewhere, I’m not defending the status quo in any way, shape, or form. What we have today combines the worst of both capitalism and socialism. We need significant change. I just disagree about the direction of change.
michael: you really can’t claim causality between the healthcare system and longevity like that- it’s much more complex than just assuming that better healthcare access means longer lifespan. For example, though this paper’s now outdated (and I don’t know if one of its central premises is still true- that Americans who reach the age of 80 then live longer than their cohorts in Europe), another major factor is genetics of the population (which are wildly different in a country with a mostly homogeneous population than in a society with a lot of immigrants, and if I’m not mistaken I think that people of African descent have a significantly shorter lifespan than Caucasians even when other factors are corrected for.)
Add to that other factors such as lifestyle and diet (though I’ll grant you that the smoking might cancel out any positive factors for the French in that regard), and it becomes almost impossible to conclude anything at all about a difference in longevity of 2.6 years.
Maybe it’s because of my own professional background (veterinarian) that I see the obvious flaw in your logic. A doggie nation with a population of 40% Great Danes would have a lifespan averaging several years (even in ‘human years’) shorter than a doggie nation with a majority of toy poodles, no matter how good the veterinary care was in each country.
Oops, forgot the link to the paper I was referencing.
But as I said, it’s outdated anyway- I mainly wanted to draw attention to the ‘crossover effect’ in mortality that the paper describes. The authors hypothesize that immigration may explain that effect, but another possible explanation, of course, is that Americans who do live to the age of 80 (a population skewed to the genetically advantaged) then go on to live longer due to better quality healthcare and/or better access to healthcare than their European counterparts.
But either way, there’s no denying that genetics play a huge role and that differently composed populations will have statistical differences in longevity even when both groups have identical healthcare services available.
I’m not claiming direct causality, but I’m pointing out that if health care were particularly awful in France we probably would not be seeing Frenchmen outlive us.
Even that’s not necessarily supported by the evidence since there’re so many other factors that you aren’t correcting for, but since you only said "probably" I’ll give it to you.
In other words, if your doctor kills you, he shouldn’t have to worry about being sued.
I dont see how denying the existence of issues with liability insurance driving some doctors out of the profession (or at least away from the parts of the country where the liability rates are astronomical) helps your case any.
I think Mike hits it right on the head by stressing the desire for security of continued access at sub-ruinous cost. IOW, if you adopt a health plan and play into it regularly at the beginning, you don’t get arbitrarily booted out because you lost you job or came up with the wrong illness. Insurance really ought to continue to protect you when you most need it, not bail on you when you become a cost center. I don’t want to get screwed because some penny-pincher wants his <a href="http://www.baltimoresun.com/news/health/bal-chemo0223,0,7856129.story>recision bonus. </a> Obviously some of us here disagree about whether or not government is best suited to provide this sort of protection, which let’s face it, is what very many folks want. I don’t want anything free, but I do want a square deal. And I don’t trust profit-motivated entities to provide it without substantial oversight and arm-twisting. Pat, what do you think of that recision story? Do you think the punitive award is excessive? To support a point Chris made above, we DO need to worry about what sort of program gets instituted. I am shy a link to it, but I read a story just the other day about British healthcare. A woman who had cancer was denied an upper-level treatment under the national plan. She scrimped together all she had, and was selling her house, to pay for the additional $100k-ish treatment out of pocket, on top of what the gov’t service agreed to provide. And then, when the government found out, they told the woman that she had to choose between accepting the gov’t verdict or paying for ALL of her treatment. In other words, she’d have to pay out of pocket for ALL of the care if she paid for the supplemental stuff. The rationale the gov’t gave was that it wasn’t fair for the gov’t service to allow only people who could afford better care to get it. The story was rife with other instances where folks sought out-of-pocket supplementation.I’ll see if I can track it down again. Technically, supplementation is not allowed in Britain, but it’s not uncommon. This just goes to show that if we do undertake some sort of single-payer gov’t run plan, we’ll need a hardy council of anti-idiocy sentinels. And the track record aint good there.
The recision story is <a href="http://www.baltimoresun.com/news/health/bal-chemo0223,0,7856129.story">here</a>. The British healthcare anecdote, via Tyler Cowen at Marginal Revolution, is <a href="http://www.nytimes.com/2008/02/21/world/europe/21britain.html?_r=1&hp&oref=slogin">here</a>.
There are scare stories about state run medicine. But there are the same in US medicine. My sister died — at age 48, leaving a 2 year old daughter — at least in part because her doctor could not perform a simple ultrasound — recommended by two other doctors — under the insurance guidelines. She chose not to fight the company and died of cancer that might have been cured if caught earlier as it likely would have been.
michael: that is awful about your sister and although anecdotes only go so far, I certainly have experienced enough battles with insurance companies to know that there are a LOT of those anecdotes to go around. Plus, my Dad died days after he’d finally gotten on the heart transplant list, having been delayed because my parents had to scrape up lots of cash before he could even be considered. We’ll never know if he would have had a chance at getting an organ match before his heart decompensated.
So believe me, like Pat, I’m not arguing for the status quo and it grates on me that the GOP didn’t even attempt corrective measures that could logically be employed to reduce costs and enforce insurance company regulations better, while we had a GOP majority in two branches and could potentially have had a hand in making the system function better and more affordably. And I agree that McCain needs to get some wonks to rewrite his plan, though I think your criticism is overstated and your review of Obama’s plan is insufficiently critical.