Obamacare

In Health-Care Policy, as in Hollywood, Nobody Knows Anything

|

Over at The Atlantic, Derek Thompson addresses the problems of uncertainty and political interference in health-care reform: 

An empowered IMAC (or MedPAC), as envisioned by the administration, is an advisory board of unknown doctors and economists, with responsibilities that haven't been codified, whose job is to make recommendations we haven't thought of yet. Scoring the fiscal benefit of the council (which already exists, but in a weaker form than Obama would like) is an exercise in fantastical thinking. It is the opposite of a "scoreable offset."

But that sword cuts both ways: We shouldn't trust the CBO to accurately predict the council's cost-saving potential, but we also shouldn't eat up any promises that the panacea to our health care crisis is to de-politicize our health care policy. The reason is simple: There is no way to de-politicize our health care policy. 

Obama told the Post: "There have to be a series of modifications over the course of a series of years, and we have to take that out of politics." But health care is a multi-trillion industry with an ocean of special interests that will never leave politics. If MedPAC recommends a policy change that dramatically rations care for seniors to save costs, you can bet Congress is going to hear from the AARP. If it recommends a policy that cuts pay for doctors, then ditto the AMA. An IMAC program of quasi-oracle status would still be vulnerable to elections and future laws, so that stepping on powerful toes could ultimately get the program booted in another Congress. You can try to take public policy out of Washington, but you'll never take the Washington out of public policy.

Thompson is right up to a point: William Goldman's famous dictum about the movie business—"Nobody knows anything"—is also largely true about health-care policy. And practically, it would be extremely difficult to disentangle politics from health-care in the short run.

But, at least for those of us wary of government interference in medical care and decisions, the current political problems facing health-care do suggest a larger lesson, and perhaps a long-term strategy: If you want to de-politicize health care, the solution isn't more government, more bureaucracy, or more "independent" commissions; instead, it's, to the extent possible, to take government out of the picture. 

Last week, I discussed some of the problems with IMAC. Read Reason's archive of health-care coverage here

NEXT: Beam Me Up, Sarah: William Shatner Reads Palin's Exit Speech

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. The reason is simple: There is no way to de-politicize our health care policy.

    If you get the government completely out of health care, you’ve depoliticized it.

    Otherwise, yeah, you can’t depoliticize something that politicians can control.

  2. “our health care crisis”

    What crisis? Be specific and compare and contrast the “crisis” with the state of healthcare 12 and 60 months ago.

    Why is it that people believe if something is repeated enough in many places by tall people with proper English and well-shined shoes it is true?

  3. “Obama told the Post: “There have to be a series of modifications over the course of a series of years, and we have to take that out of politics.”

    What does he mean “take that out of politics”? I think he means take the decision out of the hands of the voters and elected officials and give it to unelected bureaucrats. For Obama the problem is all of the pesky voters getting involved and keeping the enlighted elite from doing their jobs. How dare people expect to have a say in how the system is run!!

  4. You’ve got to start from where you are, not from where you wish you were. The Europeans have much more comprehensive and cheaper health care plans than we have, but they got there because their health care systems were essentially destroyed during World War II. We grew our private health care system around World War II-the only way that American employers could give their employees a raise was to enhance health-insurance benefits-so to change it to a totally public plan is crazy.

    – Howard Dean

  5. Repeat after me:

    “If the views and opinions of others are ideology, so are my views and opinions.”

    “If the needs and wants of others are special interests, then my needs and wants are special interests.”

    “My views aren’t ‘merely common sense’ and my needs aren’t ‘the common good’, because I am a mere citizen just like everyone else. My shit stinks just as bad as everyone else’s.”

    Thank you.

  6. Can I add:

    “If you demand the govt get politics out of an issue, you are making a demand of govt. Do you know what making a demand of govt called? It is called POLITICS, even when you do it.”

  7. Ahhh, the contemptous reasonings of an unreasonable blasphemer on a site called Reason.

  8. Repeat after me:

    “If you choose not to decide, you still have made a choice”

  9. Johnny, that’s like… deep, man.

    How ’bout: “If you object to me fucking your mom in her sleep, you’re restricting my freedom. You know what restricting people is? It’s FASCISM, man.”

  10. Obama To Hold Health Care Metaphor Among Produce

    Well, he’s calling it a town hall, but who can miss the message of the setting?

    President’s town hall will be in the perishables section of the store, which will close several hrs Wed.

    “So, your grandma is kinda like this week-old cantaloupe: wrinkly, slowly dying, overly sweet, and frankly, not worth a lot of money.”

  11. Obama To Hold Health Care Metaphor Among Produce

    Well, he’s calling it a town hall, but who can miss the message of the setting?

    President’s town hall will be in the perishables section of the store, which will close several hrs Wed.

    I hope nobody tosses a pineapple at him.

  12. A couple more great lessons from Johnny Longtorso…

    “To learn my teachings, I must first teach you how to learn.”

    “He who questions training only trains himself at asking questions.”

    “But until you learn to master your rage, your rage will become your master”

    Brilliant guy you are!

  13. “Is good to meet girl in park. Is better to park meat in girl.”

  14. Wherever you go, there you are.

  15. Park on a driveway, drive on a Parkway?

  16. Funny how much venom a simple comment of “you’re a fallible human being, too” can generate.

  17. What’s Neil Peart doing here? 😛

  18. “Sean W. Malone | July 28, 2009, 7:20pm | #

    What’s Neil Peart doing here? :P”

    Don’t go gittin all geddy on us sean. You really oughtta get a life son.

  19. Geddy Lee; best bass player ever!

  20. Why is it that people believe if something is repeated enough in many places by tall people with proper English and well-shined shoes it is true?

    Seriously, I’ve incidentally been researching health care coverage and health care spending lately for work (not for political debate purposes, though it is topical), and this stuff they come up with is total bullshit. Health care expenditures, as a proportion of the average consumer’s spending, have changed little since 1990, at most shifting up by 1 or 2 percent of average consumer spending as a whole and for all income groups. And it has constantly been going up over that 18 year period, so because they are 1 or 2 percent higher now does not mean that they won’t be 1 or 2 percent lower in three years. Further health care expenses are still only about 9% of most household’s spending, maybe 11% for the lowest income groups (and that’s just because they have lower spending overall–when you adjust for that they come out pretty evenly). Housing-related spending makes up 25-40 percent of all expenses for consumer units–a much more significant strain on the average person’s finances. We can see how “Mortgages for All” worked out, though of course health insurance is an entirely different category of expense than an equity-bearing investment so the analogy is not really fair.

    But the point is, why so much attention on such a minor part of everybody’s living expenses? Why so much hysteria over an economic sector that will only seriously have a negative financial impact on an extremely small segment of the country who happen to have serious medical problems as well as be uninsured? I hear a lot of anecdotes about people “going into debt from medical care” or “dying because they couldn’t afford medical care”–and it sucks that some people develop diseases or have accidents and die, but seriously, we all fucking die somehow–but I would think that if it happened with any real frequency, there would be some numbers and statistics too. I hear a lot about 47 million uninsured (seen estimates as high as 52 million, but I never hear about the hypothetical 3 million who die from lack of insurance. Sure, the people who spread that shit are swayed by the warm and fuzzy stuff, but the people who make that shit up initially would throw in some numbers if they had them. Legislators always want numbers if they’re available, though if they aren’t, that won’t stop them from cramming their standard crap through the corn hole that is Congress anyway.

  21. Correction, “constantly going up over the last 18 years” in the first paragraph should actually read “constantly going up and down over the last 18 years”

  22. “If you want to de-politicize health care, the solution isn’t more government, more bureaucracy, or more ‘independent’ commissions; instead, it’s, to the extent possible, to take government out of the picture.”

    This statement is a form of tautology. Discuss.

  23. # ben tej | July 29, 2009, 12:12am | #

    # Health care expenditures, as a proportion of
    # the average consumer’s spending, have
    # changed little since 1990, at most shifting # up by 1 or 2 percent of average consumer
    # spending as a whole and for all income
    # groups. And it has constantly been going up
    # over that 18 year period, so because they
    # are 1 or 2 percent higher now does not mean
    # that they won’t be 1 or 2 percent lower in
    # three years. Further health care expenses
    # are still only about 9% of most household’s
    # spending, maybe 11% for the lowest income
    # groups … Housing-related spending makes
    # up 25-40 percent of all expenses for
    # consumer units…

    #…why so much attention on such a minor part
    # of everybody’s living expenses?

    Perhaps because 1) for those who actually have health insurance, either they pay big premiums through payroll deduction, or their employers do, or both — and that money could otherwise be going into the employee’s pocket; 2) for most of those who don’t have health insurance, they are one major health incident away from being bankrupt. That is to say, the financial downside is huge.

    Health care needs to be affordable, as food, clothing, transportation, and yes, even housing are, so that most people, most of the time, won’t have or need “insurance” or anything like it to access adequate health care for themselves and their dependents. Government intercession will not make it so. The only “reforms” that will lead in a net positive direction are free-market reforms. Medicine needs to become subject to competition, innovation, and the choices of fully-informed and empowered patient/customers.

  24. Health care needs to be affordable, as food, clothing, transportation, and yes, even housing are, so that most people, most of the time, won’t have or need “insurance” or anything like it to access adequate health care for themselves and their dependents.

    Yes, but as I pointed out above, health care is a relatively affordable living expense, especially compared to housing. It’s more extraneous than housing, which is why people opt out of health insurance instead of their rent or mortgages. The health insurance deductions on my paycheck are more affordable than my income taxes. So the question remains, why the hysteria?

    I agree with needing free market reforms, but I don’t think that’s something you can exactly accomplish with hysteria, because of course, to the average person, making free market reforms doesn’t look like you’re doing something. And as we all know, government’s job is to “DO SOMETHING!”

Please to post comments

Comments are closed.