Thursday, October 01, 2009

A little health care debate

Found this article at Real Clear Politics. It is a non-spittle-flecked, straightforward presentation of arguments for a public option. I thought I'd go through it, and respond in like kind, from the small storehouse of knowledge I have gleaned in the debate so far.

'The strangest aspect of the debate over a public option for health coverage is that the centrists who oppose it should actually love it.'

Advocates of the full-on socialised single-payer system are repeatedly to be heard indicating that public-option government health insurance is an excellent waypoint/gateway to their preferred end-state. A responsible centrist/moderate would therefore hear 'trojan horse' when the latter is proffered.

'It doesn't involve a government takeover of the health care system.'

No serious person suggests that the public-option government health insurance in and of itself is a takeover of the health-care system.

'The idea is that only consumers who wanted to enroll in a government-run health plan would do so. Anyone who preferred private insurance could get it.'

Thank you for not taking away our private insurance. Very grateful. Awfully kind of you old chap. What about the very large majority of people who get their insurance through their employer? Will they be unaffected? Will you guaruntee that every employer will continue to offer to their employees the same private health insurance plan that they do right now?

'The public option also uses government exactly as advocates of market economics say it should be deployed: Not as a controlling entity but as a nudge toward greater competition. Fans of the market rightly oppose monopolies. But in many places, a small number of insurance companies -- sometimes only one -- dominate the market. The public option is a monopoly-buster.'

The 'every tool is hammer if you need it to be' argument. If you want greater competition between insurance companies offering health insurance, there are vastly simpler, less intrusive and less costly ways to do it than create a brand new government-run health insurance program. Allowing interstate competition for one. Removing all legal barriers to the free market in health insurance would be a far more elegant solution, especially the artificial links between employment and health insurance. But something tells me that your end goal is not a healthy market in health insurance... this is more of a tactical argument than a genuine one.

The lie can be put to this very weak argument by comparing it to other industries. Has the government promoted competition in the supermarket sector by creating its own chain of supermarkets. You can't imagine them doing it, because it is so obviously not the right tool for the job. So why is it the right tool for creating a healthy health insurance market?

There is also no mention of the nonsense that any insurance company in the world, no matter how big, could compete with the deepest pockets in the world, the United States government. Because of the coercive confiscatory power of taxation, the US government WILL out-compete you. In this David and Goliath battle, Goliath will always win. That's not competition, that's annihilation. An example? Where is the private sector competitor to MediCare? Doesn't exist. Why not? Because absolutely nobody could compete with the positively gargantuan MediCare system for either economies of scale or legally-mandated coercive pricing. Should there be competition with MediCare? Definitely! Should MediCare exist? Not if you ever want a market solution to the problems of end-of-life health care.

'Centrists tell us they want to hold down spending and fight deficits. Strong versions of the public option, as the Congressional Budget Office showed in its scoring of Sen. Jay Rockefeller's proposal, cut the costs of insuring everyone.'

What is the effect on Government spending and deficit reduction of no action? I bet in every possible scenario, no action would cost less than imposing on government a huge new responsibility. But you gently move the goalposts in that last phrase. So what is your concern: government fiscal health, or cheap universal health coverage? Needless to say, those two concerns have completely different imperatives.

'Unfortunately, the debate over the public option has rarely concentrated on the substance of the idea. Instead, it has been almost entirely ideological.'

Yet more pointless insults aimed at those you are trying to persuade. I'm going to send you a copy of 'How to win friends and Influence people' gratis. 99% of the articles I have read go directly to the substance of the policies proposed while leaving aside ad hominems like this one.

'Because opponents know from polling that the public wants the chance to choose a government plan, they move the discourse to abstract and often demagogic ground. The most revealing "argument" during the Senate Finance Committee's public option debate on Tuesday came from Sen. Chuck Grassley.
"The government is not a fair competitor," Grassley said. "It's a predator."'

There is no doubt about the polling on a government provided health insurance option is squarely in favour. I suspect that this is a function of how polling works. If you ask a question of the public which they fundamentally don't understand, but which sounds positive and good, most people will agree to the proposition (rather than admit that they don't understand, and risk looking stupid). I would like to see the poll numbers on a government provided health insurance option when all the ramifications of creating it, paying for it, enlarging the government role in society and reducing the role of private industry are explained in detail to the poll respondents.

I don't agree with Grassleys formulation- I would not say that the government itself is an unfair competitor. Many many of the politicians and wonks driving the public option intend unfair competition, however. They don't intend for the public option to do any of the things Dionne lists above. They intend for it to be a trojan horse for their REAL goal, which is single-payer socialist healthcare. Sadly, Senator Grassley, like so many American politicians, couldn't form a coherent argument for going to lunch.

The public health insurance option is intended to be an unfair competitor to drive private insurers from the marketplace, and create a situation 'on the ground' which presents single-payer socialist healthcare as the only reasonable development. That is the publicly stated intention of large numbers of advocates of this policy, including Barack Obama back when he spoke out loud about his genuine intentions. It is both insulting and disingenuous to pretend the opposite.

'Grassley was then forced to explain how he felt about Medicare. Is it predatory for government to pay health bills for the elderly? Is Social Security, which lives side by side with private pension and savings plans, predatory? Is it predatory for government to regulate, well, predatory lenders or stock swindlers or bank boodlers?'

Good! Grind the bastard down! Aux barricades! Ok, back to the calm reasoned discussion...

MediCare, MedicAid and Social Security move the following three functions from civil society into the orbit of government- medical provision for the elderly, medical provision for the very poor and basic housing and food for the very poor. Is there a valid public policy objection to the wholesale shift of civil society functions into the government orbit? Absolutely. The argument is this: none of the functions above are universal provisions (although MediCare comes close). The public option health insurance is not a universal provision either- but is intended as a first step to government provided universal health care provision. As such, it would mean moving another huge tranche of American life from civil society into the government orbit.

Oh, and just to answer your question, it is not predatory 'for government to regulate, well, predatory lenders or stock swindlers or bank boodlers', in case you were hanging out for an answer.

'Democrats have been far too timid in taking on the right wing's arguments against government.' Yeah, whatever.

'They have been defensive at a moment when they should be going on offense by insisting that government can expand human freedom and give people options they would not otherwise have.'

Thats coy. What Democrats have been offering is an expansion of human freedom and new options while paying the same taxes, not interfering with the free market, preserving all the good things about the current situation, not increasing US Government debt and not increasing the government footprint in American life. Which is complete bullshit. Nobody believes you.

'Consider universal K-12 education, loans and grants to help students attend college, clean water systems, and unemployment compensation so people can get by while they look for the next job. A public insurance option lies squarely within this American tradition of using government to open new avenues of choice and opportunity.'

Talk about a rag bag. Universal education is by no means a big win. There are very good arguments that apart from a very basic reading, writing and arithmetic, coerced universal schooling is a waste of everybodies time. Choosing to get an education is light years from having to have an education. In many countries, universal education has had very mixed results while always costing prodigious amounts of money. Loans and grants to help students attend college have existed for as long as colleges have- just not provided by the government. They would remain if the government stopped providing them in the future. We have clean water in the UK, and the government has nothing to do with it. Unemployment compensation is nice, but not essential. It also lessens the motivation to go out and find a new job.

The concluding sentance bears no relation to the previous examples. What new vistas of choice and opportunity does unemployment comp give you? None. Its just a stop-gap until you go find a job. The crucial fact here is that none of the tasks being performed by the federal government mentioned here exclusively require the federal government to get them done. They don't require the federal governments heft to get them done. Education used to be provided locally, by private funds and by charities and religious groups. Student loans, bursaries and scholarships have always been provided by civil society groups, banks and charities. Unemployment compensation is a luxury- nobody really needs to pay this out at all. Just go get a job.

'Using government' is not necessary- its just a bad habit copied from statists and communists.

'Yet supporters of the option and the Obama administration have made unforced errors of their own that led us to Tuesday's votes.

The public option is a means to an end, not simply the symbol it has become in some progressive circles. From the beginning, the public option should have been seen as part of a larger effort to make insurance affordable. This means that its promoters need to worry more than they have so far about subsidies for the uninsured. If this bill does not help make insurance affordable for middle-income families, it will be a failure.'

Dionne finally puts his own policy preference squarely on the table. The purpose of health care reform is to make insurance affordable. That means that all other considerations are subsidiary to that goal. And he doesn't mean just affordable to the poorest people, but middle-income families. I'm guessing that that policy would be startlingly unpopular with the American public. The Congressional Democrats and Obama have only kept the public vaguely on board with their stated policies because they insist they will be CHEAPER in taxation terms than the current situation, not MORE EXPENSIVE. Higher taxes to pay for expensive health-care for low and middle income people gets virtually no support when polled. There is no free stuff. 'Affordable' health insurance to low and middle income families means higher taxes for middle income and high income families.

See, when you get down to the nitty gritty, to the details and away from the airy fairy promises of ice cream and cake for everybody forever, nothing validates the Democrat assertions on health reform.

'As for the Obama administration, it's been too ready to hint that it would throw the option overboard. Its highly public unfaithfulness to the view it purported to hold simultaneously enraged progressives and weakened its own bargaining position.'

That is entirely beside the policy point.

'And one more pragmatic consideration: Americans wonder if all this noise around health care will do anything to change their lives. By offering a genuinely new insurance product of its own, the government would be acting as an innovator, a prod for change and, to borrow a phrase, an insurer we could believe in. As Max Baucus has taught us, there's a lot to like about that.'

A genuinely new insurance product? They are going to cover diseases nobody else thought of? Provide access to equipment nobody else does? Get you in to see doctors no one else gets to see? This is semantic bollocks. The insurance would be the same ol' insurance everybody offers- just organised by the government bureaucrats you may remember from such previous hits as the IRS and the DMV. 'An insurer we could believe in'? Government bureacracy as receptacle for religious fervour? What a weirdo.

Quick question in closing- why interpolate all that stuff about tactical commentary and process detail into an article trying to argue the substantive policy justifications? Its just annoying.

How would I grade this effort? D-

What was the best thing about it? It does adduce actual evidence towards its assertions.

What was the worst thing about it? Does not manage to supply even close to a legitimate justification why the federal government of the United States should provide a health insurance plan to citizens.

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