Wednesday, October 7, 2009

Change I believe in

I recently contacted two of my friends, some of the fiercest and smartest debaters I know, and challenged them to debate me on health care and a topic of their choice. I wrote the following starting essay as a beginning of our debate, but life has gotten hectic and I'm not sure if the whole debate will ever take place. If they finish a complete rebuttal, or if any of you have any thoughts, I will be glad to post them on this blog or have a public debate on things you feel strongly about. In case they never get back to me with a full rebuttal, however, I wanted my thoughts to be public as soon as possible, so that we, as Americans, can start to have the national discussion about what, if anything, needs to be done with health care.

I believe that we should pass the health care reforms that President Obama outlined in his address to Congress.

Although there are many things that could be written for or against this plan (and I have conscripted a friend to help me elucidate the other side to my arguments), I will show that overall, passing the plan advocated by President Obama would bring about substantially more benefits than costs.

When proposing a plan (or a debate platitude), the most important first step is showing that there is a problem with the status quo.

The second most insidious lie surrounding health care (behind the whole 'death panels' thing) is that “we have the best medical system in the world.” This is a pretty standard deflection in debate, make a verifiably true, but also totally unrelated point in order to support your claim. It is true that America leads the world in medical advances, new drug developments, and quality of top-tier doctors, the problem that needs addressing, however, is that a significant portion of Americans are outside the medical care system. Warren Buffett and rich foreign nationals may be able to get the best medical care in the world here in America, but their good fortune is poor reason to continue with a horribly flawed medical system, in which 46 million people have no insurance.

This leads to the question: are the 46 million uninsured going completely without health care? In point of fact, many of the uninsured in America are still getting health care when they need it. The 46 million number, although fun and effective to throw around (as I myself do all the time), does not tell the whole story. When an uninsured person gets critically sick and needs to go to the hospital they do so. Very few people, it seems, are willing to endure a gunshot wound or broken arm, simply because they don’t have the money to pay a doctor. If we were living in a purely capitalistic society, the sick poor would be kicked to the curb, made to soothe their lacerations only with the knowledge that capitalism has justly condemned them. Surely only a few generations will go by before the poor wise up, recognize that they have incentive to escape the soul-crushing poverty which they so enjoy, and get a good job which gives them health insurance.

As with any externalities, this free health care that we’re dispensing in emergency rooms all over the country needs to be paid by someone. It shouldn’t take a PhD in economics to realize that we are all paying that cost, either directly through the government, who needs to bail out failing hospitals, or in the form of higher hospital and insurance costs; just like retailers needs to raise their prices to compensate for losses to shoplifters, we are already paying for the uninsured in the status quo.

The real losers in the current system are not the uninsured poor, who can fairly easily get access to free clinics or Medicaid, or who can simply discharge their debts through bankruptcy (my plan, should I ever get seriously ill while I don’t have insurance), but the under-insured members of the middle class and those who can no longer get insurance in the market. When a middle class person gets in a serious accident or comes down with a life-threatening illness, their assets are in danger. A significant portion of bankruptcies are a direct consequence of medical bills.

We’re in the worst possible middle-ground with American health care. We’re socialist enough that there is very little incentive for people to take care of themselves or avoid expensive medical costs, since society will pay them one way or another. This is at least partially why there are so many uninsured in America. On the other hand, we’re capitalist enough to have private insurance companies in the marketplace as well. Those companies provide a service to their customers, but are free to pick and choose whom they want to cover (even sometimes utilizing recision to retroactively revoke the health care policies of customers who should have been covered), sucking the marrow from the bones, as it were, but leaving the ill to be covered by public moneys. There is a good argument to be made that we’d be better off either competing for the fees from the healthy to subsidize the risks of the poor (this is the purpose of insurance, I would point out) in a government program, or dropping government involvement in health care at all, leaving the market to solve our problems if it can make a profit, allowing the sick and aged to die off and “reduce the surplus population.”

For those of you who believe that there are better tweaks to Obama’s plan in the vapor or in the hands of the Republicans, I would ask where those ideas have been for the last decade. During the whole time that the Republicans had control of the congress and the White House, the changes made to the American health care system probably did more harm than good, funneling public money to private insurance companies without really giving benefits to their consumers. It is time to acknowledge that the market system is not only failing to fix the problems in our health care system, they are likely the very root of the problems.


Rosiecat said...

Daine, that tidbit about recision to retroactively deny a customer her health care policy is horrifying and very sad. That can't possibly be legal! Or is it? Can you find an example where that happened to a patient in need of her insurance coverage?

direfloyd said...

The benefit/cost of dropping nukes on Afghanistan could easily be proven also bud =) Nuclear winter will solve that global warming problem!!!
You are the best debater I know, I know better than arguing with you! I will state my wife may have to switch residencies or be out $200K and a job once this goes through. There are significant restrictions on pathology work in the current senate bill. Proof will be needed before a biopsy can even be preformed to keep costs down... and let people die essentially... but that does fit the cost/benefit ratio you talk about =) We need to talk soon bud!!!

You will approve of this also!

Brandon Miltgen said...

Daine—you're as sharp a knife as ever. I'm all for health care reform. My fam and I took the time to rent and watch Michael Moore's Sicko, which albeit may be liberally biased, showed a whole lot of hard facts that neither dem or republican should in good conscience be able to ignore.

BTW, you are my only official blog "follower". Although some people check it out, I'm lonely. Let me know if you're ever in West MI and if you have time you and Amanda can come up to Spring Lake and check out our new house!

Jon Ogden said...

I agree that we need reform, agree that we're in the worst mix of capitalism/socialism (excellent way to put it), and I agree that a public option in the vein France has wouldn't be the worst thing in the world.

I also think, if I can emphasize my agreement with you, that health care reform is the most important thing on the bill right now.

But I worry about cost. I saw the news today that the CBO estimated that the current bill would cost $829 billion and reduce the deficit by $81 billion over the course of ten years (here:

But the CBO certainly didn't project Medicare to turn out to be the wreck it has become, and even if the first ten years of this additional public option barely scrapes by under adding to the deficit, as the CBO has projected, I've seen nothing that proves we won't repeat our troubles 40 years from now.

This isn't just a trivial complaint. What happens if we go to borrow from China one day and they reject the request?

What we need, I think, is a bill that doesn't focus on expanding coverage or developing new technology. What we need is a bill that gets serious about fraud and corruption and gives incentive for more family practitioners. As it is, we've come to expect specialized health care as right and as a nation burgeoning with obesity, that puts us in a tight spot. We have to stop spending millions of dollars for the elderly to live a few more months in a state of vegitation; we have to stop paying for 14-hour miracle surgeries (surgeries that get big news coverage and lots of notoriety in comparison with your common family doctor).

Perhaps we could come up with a solution so that everyone could afford a family doctor, but I don't see a way, in world of limited funds and in a nation burdened by debt, to give specialized health care for everyone without ruining the system.

Perhaps I'm too cynical, but I think that not adding a public option in the end will be the kindest, most charitable option.

What about this idea, from Martin Feldstein, Harvard Economist?

Or this from Greg Mankiw's blog (also a Harvard Economist)? He's been saying lots of good things about this topic:

Jon Ogden said...
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