Obamacare

People Love Health Care Reform's Benefits As Long As They Don't Have to Pay For Them

|

As I noted in a column last week, health care reform supporters have repeatedly noted that, despite polls showing a majority of the public opposes the Democrats' health care legislation, individual elements of health care reform poll well. The problem with using this as an argument for reform, of course, is that lots of things sound great when you fail to consider the costs and trade-offs; I'd love a brand new 70-inch flat panel television and a lifetime supply of Doritos, but I'm not getting either. And, as I argued in the column, there's good evidence to suggest that the public isn't interested in the trade-offs reform's benefits would require. A new Zogby poll seems to confirm this notion. From a summary in The Hill

The poll showed the the public is strongly in favor of some of their key components, such as forbiding insurance companies to deny coverage based on pre-existing conditions, establishing a health insurance exchange marketplace, prohibiting women from being charged higher premiums and requiring most employers to provide health benefits.

These same respondents, however, demonstrated resistance to making tradeoffs in exchange for these benefits by stating their opposition to paying more taxes, instituting cuts in Medicare spending or being required by law to obtain health coverage.

System, heal thyself?

That wasn't the only bad news for health care reform advocates; Zogby also found that a majority of Americans want Congress to start over on the reform process:

In a brutal assessment of the Democratically authored healthcare reform bills pending in Congress and the party's approach to healthcare, more than half of the respondents to a new Zogby International-University of Texas Health Science Center poll said that lawmakers should start from scratch.

Of the more than 2,500 people surveyed from Jan. 29 to Feb. 1, 57 percent agreed with a statement that Congress should start over—which is exactly what Republicans are demanding and what President Barack Obama insists he will not do.

Of course, it's not clear what sort of revised and resubmitted reform plan Americans would support. As Philip Klein says, the public favors all sorts of health care benefits but isn't interested in any of the usual ways—higher taxes, changes to Medicare—to pay for them. You could make the Weisbergian point that this desire for benefits without cost is childish, or you could say that it's basically sensible—a reasonable willingness to reckon with the cost of benefits that might otherwise sound great. But either way, I think it shows one major reason why health care shouldn't be a centrally managed, consensus project, but instead should be left to individuals who can make their own decisions about what they're willing to pay for and what they're not. 

NEXT: Were Baseball Hall of Famers Rabbit Maranville and Johnny Evers Nazis?

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. Well call me a Weisbergian then. If someone asked me if I favored prohibiting discrimination based on preexisting conditions, I would say no because I know that either the cost of insurance is going to get hideous, or private insurance will go extinct.

    But most people don’t think about the consequences, they just say what they want. Like children.

    1. If you had your own insurance and could keep it from employer to employer, then this wouldn’t be a problem. You would buy your insurance when you were 20 and keep it until you died. Then when you got “the condition” it wouldn’t be pre-existing and would be covered.

      Of course, some conditions are pre-existing from birth, and that demonstrates once again that life ain’t fair. But life’s unfairness is still not an excuse for healthcare nationalization or bureaucratization or whatever the Demopublicans are demanding this month.

      1. Of course, some conditions are pre-existing from birth, and that demonstrates once again that life ain’t fair.

        So have parents purchase health care before birth, with a guarantee you can stay on the plan if you want.

    2. I thought the Weisbergian point was that it was that everything bad in the world is all the libertarains’ fault

    3. I’d just say no cause I like to discriminate against people with pre-existing conditions, Weisbergian. Plus that’s totally stupid from an actuarial standpoint.

      And I prefer “Weisbergander” – probably cause I’m from Michigan.

  2. Actually, as long as you require everyone to get insurance, then banning discrimation of pre-existing conditions is workable. And when you think about it these people are going to get covered one way or another. Either through insurance, or through the tax payer.

    I think a bigger issue is effecting people’s choices going foward. So they pay for for health insurance based on their current lifestyle choices. After all pre-existing conditions by their very nature are a sunk cost.

    1. Actually, as long as you require everyone to get insurance, then banning discrimation of pre-existing conditions is workable.

      Yes, but that’s the point. People are massively opposed to requiring everyone to buy insurance (19% support), even as they support the ban on higher premima pre-existing conditions.

    2. The trouble with mandatory insurance is, if Massachusetts is any example, that insurance costs will go up significantly for the individual, but with little added benefit in terms of covering the uninsured. All you’ve done is make an already existing product more expensive and less affordable.

      1. More expensive and less affordable? MA can’t get anything right.

        1. Yeah, I know, it was redundant.

    3. Re: Kroneborge,

      Actually, as long as you require everyone to get insurance, then banning discrimation of pre-existing conditions is workable. And when you think about it these people are going to get covered one way or another. Either through insurance, or through the tax payer.

      And if you require everybody to purchase car insurance, whether they have a car or not or want to or not, then 16 year olds, drunks and the accident prone will be able to drive more affordably, because after all it will be either the insured or the taxpayers that foot the bill one way or the other.

      I know, it is not exactly the same, but the point is that rather than finding new and seemingly ingenious ways to socialize the costs, let’s rather focus on how to return to the point where people take care of themselves individually.

      1. I guess the point with healthcare though, is that we are already, (and probably always will be) socializing the costs. Therefore, we should be looking at the best ways to get the indvidual (instead of society) to pay their own way.

        As for protecting liberty, I think you could include an opt out clause, where you would state that you would not recieve any medical care that you did not cover on your own in advance if you chose not to get insurance.

        1. Therefore, we should be looking at the best ways to get the indvidual (instead of society) to pay their own way.

          The best way to get the individual instead of society to pay his own way is to make sure he is bankrupt before spending one dime of public monies on him.

          Health insurance does not insure one’s health as much as it insures one’s finances.

          Make it easy for individuals to own health insurance — e.g., allow interstate (or international) provision of insurance, give employer-based and individual health insurance the same tax treatment, get rid of Medicare — and you will find that people will insure themselves in order to save their lifestyles.

          Society can go ahead and provide a safety net to those who choose not to insure their lifestyles after their lifestyles are liquidated.

    4. Actually, as long as you require everyone to get insurance, then banning discrimation of pre-existing conditions is workable. Liberty is your unacceptible outcome.

      FIFY

  3. This kind of reminds me of liberals claiming that Medicare is a “success “because of favorable reviews given to it in surveys of the beneficiaries.

    What a surprise that people getting stuff paid for by somebody else likes that arrangement!

    Why anyone should think that is proof of “success” is beyond me.

  4. I’d love a brand new 70-inch flat panel television and a lifetime supply of Doritos, but I’m not getting either.

    Be patient, Peter. You’ll get *both* when the HCR savings kick in.

  5. “I’d love a brand new 70-inch flat panel television and a lifetime supply of Doritos, but I’m not getting either.”

    Work harder.

    1. I think he meant cause his mom won’t let him.

  6. I don’t know why people are surprised by this or somehow look at it as evidence of people being irrational. People are perfectly rational. Imagine a pollster asking me two questions.

    1. Would you like to own a 2010 Astin Martin DB9?

    2. Would you like to have $2000 a month taken out of your check to pay for your car note and insurance?

    My answer to one will be yes and to two will be no. Yeah, I would love to have a DB9. But I don’t have a DB9 and won’t be buying one anytime soon because the cost of doing so is not practical.

    It is the same thing here. People love the idea of doing away with the pre-existing condition exclusion when taken in isolation. But when they are given a plan that does this at the cost of mandating everyone buy insurance, they decline just like I decline the purchase of the DB9.

    1. I’d like to have an Audi R8 and yes, please deduct the note and insurance out of John’s paycheck. KTHXBAI.

      1. i don’t I make enough to cover it. But think about it for a moment. People like Suderman scream “people want all these benefits but they are not willing to pay for it” like it is some profound observation that justifies the government benefit. No shit. Everyone wants lots of things they are not willing to pay for. That is why we don’t have them. The solution is not to get the things people are not willing to pay for. The solution is not to give it to the people anyway and make them pay for it.

        1. Fine. Just get me a GTR then.

        2. next you’ll be telling me joe favors tax hikes because he “works” for the government instead of because he “cares”

  7. prohibiting women from being charged higher premiums

    OK then, no sex discrimination in life and auto insurance either.

    1. I demand my expected life expectancy be extended immediately!

    2. Shhh. Don’t make sense, SIV.

    3. Yay. I guarantee my life insurance premiums won’t go down, but my wife’s will go up. I’m not in favor.

  8. With the new Pay-as-you-go law in effect now… http://www.icyou.com/tags/fron…..ay-you-go+

    I was wondering how, or if, it will affect the healthcare discussions. Also, in the Zogby poll, how specific are the questions? For example, did it ask, “Do you favor healthcare reform if taxes for people making more than $500,000 go up?”

    I work for the health video website icyou; please drop us a line.

    1. For example, did it ask, “Do you favor healthcare reform if taxes for people making more than $500,000 go up?”

      A tricky question, because between President Obama’s various promises, he’s allocated all the income earned over $500,000 several times over.

      It’s completely impossible to even just lower the deficit back to Bushian levels with only confiscating all the income over $500k from each American.

  9. Johnson Wacker, the expiring Bush tax cuts are on incomes over 250,000 not 500,000 and I’d hardly call letting the rate go back up to 39.8% Confiscatory. If you make lousy economic gains in GNP nothing helps the deficit, but I;m sure if your ReBubbalikanns stage another “coup” you’ll just make rosey economic growth forecasts and cut the taxes and grow the deficit anyway, as when the good ole boys are in power the deficits never seem to matter just like every lying Corpratician from the right over the last thirty years– all while crying to your swiss banks and shouting about how we can’t (and shouldn;t) do anything to overcome the gross inequity in the system. UnChristian Greedy Carp

    We as a nation spend 15% of our economy on health care and that is far higher then any other nation and growing. We could decrease that to 10% and improve results if we went to a single payer model. The components of health care aren’t like cars with compettitive choices and NEVER will be, it’s another LIE because you don’t get in a car accident and then shop for an ambulance, shop for an emergency room, shop for a doctor, shop for a surgeon, shop for a nurse, shop for a medicine to fight the hospital aquired infection. It is a FALLACY that there is anything like a Marketplace. It’s a closed feedback loop full of actors who justify their charges by comparing charges at other places, and so on and so on. No one will stop the madness, and until we have a single payer system, American health care will CONFISCATE more in more in INSURANCE RATE HIKES until the system devours itself and cripples our economy. Only Single Payer can save us from the INFLATION rampant and present in the Health Care madness. I know I worked in a nursing home.
    Deficits are a false problem, thrown up to undermine the presidency and to attempt to keep him from doing what is the only solution to inadequate consumption during a recession, which is increase spending, turn the economic cycle around and thus create jobs which increase spending which increase jobs, etc. Be truthful your argument against deficits is to keep unemployment up until your team can take over. You can repeat your lies over and over, and put your faith in those lies but they will never be true.

  10. And for all you other libertarians who think people should just pay for your own coverage –you don’t even have a clue as to what the whole idea of insurance is. The idea to insure is a willingness to join a risk pool knowing that some people in the pool may get sick, and others will stay well. If you tried a savings model as the dumbican from the House said last week then people that are unfortunate who get sick will always end up bankrupt, and if you stay well you’ve won because you didn’t have to pay out. that is gambling and has nothing to do with insurance. A famous financial planner even said people should by long term care insurance policies because it would be impossible to save for your own long term care needs. Insurance is about if I stay well I paid insurance for the peace of mind that if I HAD gotten sick I wouldn’t be devastated. Under your logic, I shouldn’t care, being a single man with no kids, if I get sick and die broke no big deal. But if I am “stupid” and buy insurance that then saves your son or daughters life from cancer and I never collect any benefit put pay towards your childs health and recovery you say “I lose”. My God and my values don’t make me feel that way, I don’t worship money, or seek riches, but I’d happily pay health insurance along with you so when your wife or mother faces breast cancer she can rest assured it will be treated and the financial costs of health care will be spread across the widest possible pool which is the goal of health insurance reform, many young people don’t have insurance and don;t have many demands on the system, the point was to bring them into the pool at a younger age. Libertarian philosophy will never have the moral high ground, it fails the key tenant of Christianity “Love your neighbor as yourself” in your world the Libertarain/Samaratian keeps walking past the wounded man on the side of the road.

    1. Buying insurance isn’t about joining a risk pool. It’s about hedging your risks by taking a guarenteed loss in the present in place of an uncertain future loss. Assuming the risk pool is beyond a certain size (like say 1,000 people). This transaction is effectively independent of whether anyone else buys insurance.

      Large insurance pools don’t decrease the individual’s exposure to risk, they decrease the insurance company’s exposure. The individual hedges his risk by buying insurance. The insurer hedges his risk by getting as many people as possible to buy insurance, so the odds average out.

      The health insurance reform needed mandates not to get more people into the risk people, but to get people to buy insurance at rates that were artificially higher than was justified by their risk profiles. This was done so that artificially inflated premiums could be used to subsidize lower rates for higher risk people and payments to people who were already sick.

    2. I am reminded of this Bastiat quote

      “Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all.

      We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain

    3. You are trotting out Christianity on a Libertarian website. That’s a fucking riot. Any government that was run solely by Christian tenants enslaved, murdered, and persecuted the “heretics” while inevitably collapsing in a sea of corruption, fiscal disaster, and the vengeance wrought upon it by the “heretics”. If you want a more modern example of this, look no further than the Prohibition movement inadvertantly creating some of the most notorious gangsters and murderers in the history of the United States.

      Your analogy is wrong because it involves only two people: the Samaritan and the wounded man. It is the Samaritan’s own non-coerced choice to help the wounded man that makes him a Good Samaritan.
      A more appropriate analogy would involve 5 sick people (3 of them got sick through obesity and cigarette smoking) pointing spears at the Samaritan and demanding he sacrifice to them. When the Samaritan goes home, he has to tell his wife he can’t pay the rent because he was robbed. Meanwhile, of the 5 sick people the fat one is denied healthcare and dies, the smokers wait for a cancer drug to be approved by the king’s council relevant associated perscriptions (the King’s CRAP if you will) and both die before it is, and the other 2 recieve the care, however sub-standard, they “deserved”. A family is now poor and 3 people are dead all to save two souls from the reaper. Wasn’t this more sublime when it just involved one man deciding to help out another, with no threat of violence involved? And if you adhere to Christianity so fervently, you must know that “DO NOT STEAL” is one of the 10 commandments.

  11. You can get full medical coverage at the lowest price from http://bit.ly/atGzeD

  12. Andrew Sullivan picks up on this today, focusing on the Weisbergian point above, and captioning the whole thing “Big Babyism.” But then, presented with a libertarian alternative, he whines and wrings his hands for a couple hunred word in a series of “what-ifs” and then caps it off by dismissing all of America with a couple of condescending insults.

    Who is the Big Baby here? Does he ever even read the things he publishes?

  13. What fantasy land do you live in?
    Comparing a flat screen TV with health care? Are you seriously that dense or are you suggesting that addiction to HDTV can be so sever that you could potentially die without it?
    It is such a dishonest comparison. Doesn’t the Constitution state, in Article I, Section 8, that Congress can provide for common defense and general welfare? Isn’t it pretty logical to assume that general welfare includes health care, since if you are sick, you can’t really enjoy all those personal liberties?
    The only person who would ever make an argument that having access to affordable health care is like not buying a flat screen TV is a privileged idiotic libertarian who never got sick in his life before.

  14. What fantasy land do you live in?
    Comparing a flat screen TV with health care? Are you seriously that dense or are you suggesting that addiction to HDTV can be so sever that you could potentially die without it?
    It is such a dishonest comparison. Doesn’t the Constitution state, in Article I, Section 8, that Congress can provide for common defense and general welfare? Isn’t it pretty logical to assume that general welfare includes health care, since if you are sick, you can’t really enjoy all those personal liberties?
    The only person who would ever make an argument that having access to affordable health care is like not buying a flat screen TV is a privileged idiotic libertarian who never got sick in his life before.

  15. Isn’t it pretty logical to assume that general welfare includes health care, since if you are sick, you can’t really enjoy all those personal liberties?

    No. It is not logical. Such an assumption is rather, in Madison’s words, an “absurdity”…

    It has been urged and echoed, that the power “to lay and collect taxes, duties, imposts, and excises, to pay the debts, and provide for the common defense and general welfare of the United States,” amounts to an unlimited commission to exercise every power which may be alleged to be necessary for the common defense or general welfare… For what purpose could the enumeration of particular powers be inserted, if these and all others were meant to be included in the preceding general power? Nothing is more natural nor common than first to use a general phrase, and then to explain and qualify it by a recital of particulars. But the idea of an enumeration of particulars which neither explain nor qualify the general meaning, and can have no other effect than to confound and mislead, is an absurdity, which, as we are reduced to the dilemma of charging either on the authors of the objection or on the authors of the Constitution, we must take the liberty of supposing, had not its origin with the latter.

  16. Healthcare reform can start now with no high price tag

    Obama and Congress are taking the entirely wrong approach to healthcare reform. We can be doing so much right now to improve healthcare without suspicious price tags. There is nothing wrong with carrying out reform in two phases: the immediate and low price-tag phase, and the longer-term, let’s-find-the-money-first phase.

    What can be done now, with little public opposition:

    One group plan
    Everyone would have access to insurance if all insurance companies were required to offer a plan to individuals as though they were all in one large company group plan, with the same rate and no exclusions. There is no cost to taxpayers; premiums are paid by the insured.

    Guaranteed coverage and insurance market reforms
    Few would argue with such provisions. The health insurance industry has been such a Wild West that companies could promise anything and provide nothing. They suffered no bad consequences when they blatantly breached contracts with subscribers. Other than enforcement, there would be no cost to taxpayers.

    Essential benefits
    An independent committee would define an “essential benefit package” as a minimum quality standard. It would include preventive services with no co-pays or deductibles, mental health services, and oral health and vision for children. It would cap the amount that consumers have to spend per year, and cost taxpayers nothing. Insurance companies could add features to this basic package. Now they can get away with not paying for basic services because most people do not have a choice of plans, and insurance plans are far too complicated to easily compare.

    Individual responsibility
    It is time for the government to be honest about the lifestyle factors that cause many of our healthcare problems. According to an article at preventdisease.com that is based on research reported in The New England Journal of Medicine, “preventable illness makes up approximately 80% of the burden of illness and 90% of all healthcare costs,” and “preventable illnesses account for eight of the nine leading categories of death.” This is the single most important factor in lowering healthcare costs and making people healthier. But in most ways it is not a role for government. It is up to individuals to change their habits. However, the federal government certainly shouldn’t be making the situation worse. That means telling the truth about the fast food and prepared food industries. And it means requiring that government agencies and contractors use part-time and telecommuting work arrangements so people have time to exercise and prepare food at home. A national campaign aimed at employers, encouraging them to use flexible schedules for workers, such as part-time and telecommuting, could do a lot of good, with the government itself taking the lead. Cost to taxpayers: nothing. In fact, there are potentially huge savings in lowered healthcare costs.

    Pushing for results
    It is time for ratings. Netflix movies are rated. EBay sellers are rated. This is established technology. It is time for a central web site that shows us ratings for healthcare providers. Some sites do this now, but there are too many with too few ratings and it is chaotic. An insurance company doing ratings of its providers is not an unbiased source. How good is that doctor / hospital / radiology lab anyhow? How effective? How organized? How long a wait? How polite? How accurate a bill? This costs little and offers so much in savings and making healthcare very effective quickly. No more money is wasted on ineffective providers. People get well much sooner. Providers change their methods to get better ratings. Cost to taxpayers: very little. Such a site would also reveal the really bad eggs . . . moving on to . . .

    Making sure healthcare providers really do their job
    States are supposed to enforce this now, but often don’t. According to a press release from Public Citizen’s Sidney Wolfe, MD, “Most state medical boards are doing a dangerously lax job in enforcing their state medical practice acts and adequately disciplining physicians.” In another article, Dr. Wolfe said that from 1990 to 2002, just five percent of U.S. physicians caused 54 percent of the nation’s malpractice lawsuit payments, basing his numbers on information from the National Practitioner Data Bank. A constant stream of reports show that hospitals are covering up mistakes. If states were doing their job, there would be little or no malpractice lawsuits. This is far more important than tort reform. With ratings, state regulators, properly funded and monitored, could spot and check on providers who are doing a poor job before they do something really really wrong. Such a practice would eliminate payments to incompetent providers and lower malpractice cost. Cost to taxpayers: very little.

    Emphasizing primary care
    Healthcare reform needs to enhance the partnership between patient and primary care doctor. The primary care doctor is the one who needs to be on top of what is happening with a patient, with whatever record-keeping system works best for him or her (usually a hybrid of paper and database. All-electronic record-keeping is not reliable yet). Primary care doctors need to be paid as much or more than specialists and be paid for phone call and record-keeping time instead of just doctor visit time. Many doctors are forced to use a more expensive visit when a phone call will do because they don’t get paid for phone time. Cost to taxpayers: nothing

    Looking close at hospitals
    Hospitals need to be very closely audited. Not only are there often bogus charges on bills, but the charges are far far beyond costs. No one really checks this, so they keep doing it. Employees wander around hospitals that don’t seem to be doing anything. Hospitals charge for unnecessary tests, with no one making sure that tests are based on research. Anyone who complains is ignored. Medical institutions are roach motels for our hard-earned dollars. Dollars check in but they don’t check out. Cost to taxpayers: very little.

    A simple little thing
    Refrigerator magnets can save millions. Yes, you read that right. A magnet can list the phone numbers, hours, and locations of urgent care centers that can be used during weekends and evenings instead of much more expensive emergency rooms. We now waste millions on non-emergency problems being treated in emergency rooms simply because people don’t know where else to go. Cost to taxpayers: very little.

    Another simple little thing
    Money is wasted on mailed Explanation of Benefits forms from insurance companies when this information could be provided for free via a secured web site. Cost to taxpayers: nothing.

    These no- or low-cost changes would greatly improve care and save millions. They are the first step. There is no reason to delay them in order to get a “comprehensive” healthcare reform. No reform can possibly work without them in place first.

    Patty Zevallos
    media producer ? web, video, print
    http://www.pbzproductions.com

  17. Egad.

    For those who didn’t read it, allow me to summarize: Nationalize health care.

    Cost to taxpayers: very little.

    Cost to consumers: horrendously high. Cost to quality of health care: horrendously high. Cost to the economy as a whole: horrendously high.

  18. Nice post. Before finalizing your Long term care insurance policy educate yourself about it. I came across this site, it seems to contain very informative and nice information and also gives you an option to compare long term care insurance cost.

  19. Great follow up comment. I totally agree. Penis Enlargement Blog

  20. I agree with you completely. People should not feel pressured to pay an amount that they can’t afford; doing this will only cause them to ave second thoughts about getting insured. What needs to be done is to create health care payment methods that are tailored to the needs of the people.

  21. great read really interesting would love to connect and start networking

    Please get in touch http://www.simplyhealthy.co.uk
    Thanks Fraser

Please to post comments

Comments are closed.