The American Spectator

Bob| 6.9.09 @ 2:50PM

Philip, while I agree that this is a distinction without a real difference, this is NOT an ideological debate -- it is an economic one. Healthcare is approximately 17% of GDP. In a decade, with the current system, that will rise to almost 25%. Our economy is currently 2/3rds consumption. According to most measures, we do not have the most effective healthcare system. At the current rate of growth, we will not be able to compete for the manufacturing dollar. Without a manufacturing base, unemployment will continue to rise as services are peaking from a macro-economics viewpoint. We will no longer have the financial sector driving us given the current state of Wall Street. In order to be competitive in a world economy, we will need to drive healthcare costs down to about 10%. That will clearly mean some sort of rationing no matter which healthcare system we choose. Furthermore, given that social security and medicare will account for over 55% of the budget in 10 years and the boomers are retiring, this will balloon medical costs even more.

I used to work in the group insurance business and know that modified insurance is not the answer. If we force insurance companies to cover pre-existing conditions and not let them segment the market, the cost of insurance will more than double in a decade. Essentially, the more you demand of insurance companies in terms of coverage, the closer you get to a single payer system anyway.

I do believe the solution to this is a tiered system which would be uniquely American. The more you spend on insurance the better the coverage. But there needs to be a baseline. You can make that baseline not very attractive by putting in tort reform, making only the very necessary procedures part of the program, and having the lowest priority for wait times. Furthermore, coverage in the last year of life would be limited to hospice. If the government plan was this last one, it might not be so bad. There is something like this now with supplemental Medicare but it is not that sophisticated.

That said, moving the whole system to single payer would be a costly endeavor. However, we must do something. The Republican plan is as bad as the Democrat plan. So what is your solution?

Tim| 6.9.09 @ 3:06PM

My solution is to ask for more info on this magic machine that can reveal the future:
Furthermore, coverage in the last year of life would be limited to hospice.
We can all plan our needs better if the Government can tell us our date of death.

Bob| 6.9.09 @ 3:59PM

Tim, my wife was the administrator for a nursing home. The number of unnecessary procedures and tests done because of lawyers and maximizing Medicare payments and medicines was very costly. If someone had to actually pay for these extra procedures, they would ask whether they are really needed. Over half of all Medicare payments are for coverage during the last year of life. Under a tiered system, if someone wanted the full treatment, they could pay for it. If you really believe in limited government, let the individual make the decision, not the government.

Roy| 6.9.09 @ 5:01PM

Re:Bob:

It is only not an ideological debate if you don't place any value on freedom. If you do, then systems involving massive government control are less preferable than those that don't.

That is not to say that this consideration is decisive in all cases. But only if this consideration has no importance can you be "non-ideological".

Bob| 6.9.09 @ 5:29PM

Roy, if healthcare costs rise as projected, we will certainly lose our freedom in any event. If a society cannot profitably produce products, then the government is all that is left. Our current system is unsustainable in the longer term. Freedom is only attainable when a country is self-sufficient.

Let me give you a hypothetical. If a "massive government healthcare system" costs half as much as a private system and delivers the same results, would you choose the more efficient system?

I would choose the more efficient system because that means more money in our pockets. After being in the group insurance business, I highly doubt that the current configuration is the most efficient. Insurance companies are highly regulated with significant capital requirements. If you now ask them to cover pre-existing conditions and cover everyone, it is, in reality, a massive government system with private contractors. That's why it is "non-ideological", because both directions end up in the exactly the same place. Furthermore, no politicians would say that pre-existing conditions should not be covered and a mandate to cover everyone would also be a political necessity or they would not get reelected.

That's why I believe the best solution is tiered where individuals can buy the level of coverage they desire.

Smitty| 6.9.09 @ 9:12PM

Only an idiot could believe that a massive government healthcare system would be successful. Certainly, no 'real republican' would ever spout such nonsense. Troll.

Bob| 6.10.09 @ 7:31AM

Only a moron would think a tiered system is a "massive government system". Even worse, that moron would believe we could survive if we kept the current system. Put it this way -- "real Republicans" that believe otherwise are simply neanderthals. At some juncture, "real Republicans" need to come up with solutions, not complaints.

Roy| 6.10.09 @ 9:22AM

Bob: I mostly dislike the tic of describing concern for freedom as "ideological".

You've raised a hypothetical. Now let me raise one. An alien lands and offers you free health care with technology far surpassing anything humans have available - but you have to be his slave. Interested?

Once you give up freedom, it is immensely hard to get it back, and without freedom, it is impossible to keep other benefits. The Soviet Union offered free health care, sure. And you could darn well put up with drunk sons of the well connected as doctors, too, if you knew what was good for you. Even in freer societies such as Canada or Britain it is much harder to insist on high quality than it is here-and I don't think government employee unions are quite the force there that they are here. If a nurse screws up in the private sector they will be out on their ear. Ever tried to get rid of an incompetent public school teacher?

So yes, most people here place value on freedom above and beyond what green eyeshade models show.

The irony is that to a large extent I agree with what you would like to see happen to the insurance market. But I think the best thing government can do to make that happen is to stop with the regulations and tax code distortions that prevent it from happening. Oh, and the constant attempts to expand government insurance programs, which should be entirely restricted to the poorest of the poor.

Bob| 6.10.09 @ 9:29AM

Roy, we don't disagree about freedom. My point is that being competitive in a world market is essential for freedom which means we must address healthcare costs. Secondly, I believe the current system, with the additional restrictions the Republicans want, is not much different than the Democrat plan because those restrictions will make the costs rise significantly. Whether the government mandates are restrictions or a separate government plan, in the end, makes little difference as they both will be administered by private insurance companies.