Request for an answer to David Goldhill?
David Goldhill's now famous Atlantic piece makes a persuasive case against the public option and for a massive overhall of how healthcare delivery would be structured in the US. I don't know whether is his a conservative or a liberal but his argument meets the goal of expanded coverage and cost control. He doesn't scream, mention death panels or call anyone Hitler. He confronts the perverse incentives that have driven up cost without any improvement in quality and supports mostly abolishing insurance companies.
I think the main reason the Democrat's health plan is failing has little to do with death panels, Hitler references or conservative wing-nuts. They are small players. The democratic plan doesn't clearly control costs and where it tries, it uses the government monopoly to reduce costs. Medicare clearly solved the problem of universal coverage for Americans over 65, but it clearly didn't control costs despite being a monopoly. Goldhill argues that the government actually increased costs. I'm not so sure of that, but I do think no healthcare plan (public option or not) will be popular with independents or people who actually try to understand the issues if cost controls are not clear. Obama promised expanded access and cost controls. To get a consensus he will have to deliver on both of those promises. Goldhill's plan makes a plausible case for both, Obama's does not.
So all of you public option devotees, please make the case against Goldhill. Oh, and by the way simply saying that the insurance lobby wouldn't allow it isn't enough. That's the (less interesting) political case. I'm interested in the philosophical case.
Please be polite and thank you.
I think the main reason the Democrat's health plan is failing has little to do with death panels, Hitler references or conservative wing-nuts. They are small players. The democratic plan doesn't clearly control costs and where it tries, it uses the government monopoly to reduce costs. Medicare clearly solved the problem of universal coverage for Americans over 65, but it clearly didn't control costs despite being a monopoly. Goldhill argues that the government actually increased costs. I'm not so sure of that, but I do think no healthcare plan (public option or not) will be popular with independents or people who actually try to understand the issues if cost controls are not clear. Obama promised expanded access and cost controls. To get a consensus he will have to deliver on both of those promises. Goldhill's plan makes a plausible case for both, Obama's does not.
So all of you public option devotees, please make the case against Goldhill. Oh, and by the way simply saying that the insurance lobby wouldn't allow it isn't enough. That's the (less interesting) political case. I'm interested in the philosophical case.
Please be polite and thank you.
Advertisement
eamseneca, I haven't read Goldhill's piece, so I'm winging my response and hope it at least provides some answers. This comment starts out a little dry, but gets better as it goes.
You say that Medicare has failed to control costs despite being a monopoly. Well, that's an interesting statement in that it implies monopolies tend to hold down costs. Nothing could be further from the truth. That's why the Department of Justice has an Anti-Trust division.
But while Medicare has cornered the market on senior insurance, it is by no means a complete monopoly, as the program includes a vast number of private insurance plans. These plans, formerly called Medicare Advantage and now called MedicareComplete plans, were authorized under Medicare Part C. They replace or augment the insurance for hospitalization and doctors visits that is normally provided by the government under Medicare Parts A and B (the Medicare most people have).
In late 2003, the Republicans, by an infamous midnight vote, narrowly passed Medicare Part D, the prescription drug insurance program. It was unwieldy, primarily benefited the drug, insurance and hospital industries and was projected to cost $400 billion over 10 years, despite leaving a "donut hole" in coverage, which seniors themselves would have to fill in once their drug costs exceeded a certain amount (after which, coverage would resume. It's crazy, I know).
But Part D's costs have ballooned, partly because the true projected cost of the program was hidden from legislators by Republican leaders. The program currently is projected to cost more than $800 billion over the next 10 years.
At the same time. the cost of premiums for seniors and payouts by the federal government is rising for all parts of Medicare. The question is why.
1. The ranks of Medicare insureds is growing almost exponentially as Baby Boomers turn 65. This is an unprecedented graying of America that many have predicted for years would strain medical resources. Tens of millions of seniors will require increased levels of health care over the next 25 years. We are seeing only the start of the crisis now.
2. As life expectancy has increased, more seniors are staying on Medicare longer--an average of a decade longer than when the program began.
3. With the advent of the Part C plans, insurance companies found new and creative ways to sell vulnerable seniors plans that add little value but generate huge revenues paid for courtesy of the federal government. As legal entitlements, the government cannot refuse to pay.
4. Waste and fraud are rampant in Medicare.
5. The Republican-passed Medicare Part D drug program forbids the federal government from negotiating volume discounts with drug makers. The program is a gravy train for them and for insurance companies that were granted a brand new product to sell, with marketing paid for mostly by the federal government.
So, that's why Medicare is in trouble. Not because it isn't a good program. But because its being raided by the very free market that Republicans want to see more of.
September 6, 2009 1:12 AM | Reply | Permalink
Goldhill's dad was covered by Medicare and he really goes into detail its' failures and problems - it's the reason why he wrote the article. He makes a good case for health savings accounts and where the money is so it can seed any option we choose.
September 6, 2009 9:15 AM | Reply | Permalink
He's a democrat ...
First, He makes an excellent argument for health savings accounts that would satisfy the rabble-rousers on the right and take the wind out of their sails. I can see all the town hallers. tea-baggers and birthers all rallying around this option.
Second, he points out were the money will come from - our own pockets. Seems we don't realize the cost of health care benefits from our company is part of our salary - we just never see it because its taken out before taxes. Just redirecting the money from a health insurance company to a single payer/pubic option or a health saving account is nothing more than an administrative and financial record change.
While he does stress the health savings accounts over the public option, I can see where both options could be presented for the public to select which one suited their needs best. Besides, Josh himself has suggested the 65 year-old barrier to Medicare be dropped to allow everyone to participate. Since the infrastructure and its acceptance is already established it's open and ready for business on day one.
Goldhill deserves a critical read by all of us and acknowledgment that he has found a path out of the swamp of discontent we are wallowing in. Personally, I think a marriage of both public option and health savings accounts would satisfy both progressives and conservatives and allow us to move forward to some really meaningful legislation that neither side would try to dismantle later on.
September 6, 2009 9:08 AM | Reply | Permalink
eamseneca, as to your point to make the case against Goldhill, I beg to differ. That would make us no better than the opposition. Whatever we make, they'll dismantle. The talking-heads concur with this.
What we need is compromise - each side willing to give a little ground to the other so that a meaningful legislative package can be created that services the needs of each without overstepping too much into territory the other side will not support.
In the short run, both options could run simultaneously. However, over time one of the options will have a significant advantage over the other. The option that shows signs of being dysfunctional can be quietly be laid to rest and those remaining participates moved to the ongoing option.
We have already seen conservatives are locked in a battle with themselves and are confusing us with their own internal enemies. So we need to find a method by which we can ease their self-induced anxiety and fears of the unknown that is unknowable. By offering both options that pander to both political ideologies, we take the fight out of the process. And that's the key - remove the anomosity so saner heads an prevail.
September 6, 2009 9:32 AM | Reply | Permalink
Why comment if you havent read Goldhills piece? Although your comments are worthwile, they would mean a lot more if you had.
I have read his article a couple of times and it is well worth the effort to read.
I agree with Goldhill's comments and wish there were 10's of thousands more that cared enough to actually find out what is going on.
I think one of the big problems we face now is that everyone for reform wants all the problems fixed at once. Why isn't there an effort to start with one thing, like simply empty the garbage cans every 20 min's or so and once that is mastered go onto the next. The second step could be to get every care worker to clean up every time they go to a new patient.
One step could be to require hospital administrators to do their whole job, not just count the mega bucks they get in their paycheque.
But the solution to most problems seems to be that the less efficient must buy out the more efficient to bring them down to their lower level.
September 6, 2009 6:45 PM | Reply | Permalink