Inoculating Against True Health Care Reform

We can't all live at the expense of everyone else.


Critics have noted many flaws in President Barack Obama's health care overhaul: It's too expensive, too intrusive, too coercive, and too complex. But one central defect that accounts for much of the other mischief: the pretense that making us all better off is a miraculous, cost-free bonanza.

The 19th-century French economist Frederic Bastiat foresaw schemes like this when he wrote, "Government is the great fiction, through which everybody endeavors to live at the expense of everybody else." That illusion lies at the heart of the new program.

The president has gone to great lengths not to disguise this element but to celebrate it. He said early in the debate that the additional cost of the program could be paid with taxes on the rich. He vowed to oppose anything "that is primarily funded through taxing middle-class families"—which he plainly regards as the moral equivalent of drowning puppies.

But why shouldn't middle-class families bear the cost of a largely middle-class entitlement? When a typical family buys a new car, it doesn't expect someone else to make the payments. If health care reform showers so many blessings on ordinary Americans, ordinary Americans ought to be more than willing to pay the bill. If they are unwilling, maybe some rethinking is in order.

The Easter Bunny approach is not unknown among Republicans, either. They too like to hand out tasty treats. House Majority Leader Eric Cantor said in November the GOP would keep some parts of the health care reform, like requiring insurers to take applicants without regard to pre-existing conditions and to let parents keep children on their policies up to age 26. But those provisions are popular partly because their actual cost is invisible.

The general flaw also makes for particular flaws. One of those is the requirement that health insurance companies cover some 45 preventive care services at zero cost to patients—everything from depression screening to diet counseling.

As Obama has put it, "insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies, because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives." In other words, it's the pot of gold at the end of the rainbow.

Sure. And Obama is a leprechaun. Some preventive measures, such as vaccinations, save more in medical expenditures than they cost. But the idea that all preventive care pays for itself is an alluring myth.

Rutgers economist Louise Russell says that as a general matter, it doesn't save dollars. On the contrary, she noted in a 2009 article in the journal Health Affairs, "prevention usually adds to medical spending." Four out of five preventive options, she says, "add more to medical costs than they save."

But Americans have not learned to accept the word "no" when it comes to health care, and the administration has no desire to teach them. Two years ago, a federal panel dropped its recommendation that all women begin regular mammograms at age 40 (based on risks and benefits, leaving aside costs). In deference to the ensuing protests, the health care plan mandates coverage of breast cancer screening at age 40 anyway.

Consider this a harbinger: Under Obama's program, if patients and doctors demand something, the government will make sure they get it.

Many people, of course, put great importance on prevention. They'd rather get inoculated against the flu or shingles to avert a possible spell of sickness. They'd rather get screened for prostate cancer or cervical cancer if there's even a small chance it will save their lives.

But if they value such options so highly, why is it outrageous to ask them to remit something for the privilege? Letting insurers impose a co-payment or a deductible would have the effect of inducing patients not to completely disregard the issue of cost.

One of the chief ills of our health care system is that it encourages excessive consumption of medical services, which drives up total spending and wastes resources. But the preventive-care provision amounts to throwing a drowning man a hose.

If the goal is to restrain spending and make insurance affordable for all, a health care system has to put at least some direct costs on patients. We can't all live at the expense of everyone else. But we can all go broke trying.


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    1. Morning, Suki

  2. Ok but look! Obamacare will mean only hot nurses

    gm Suki

    1. Actually, it will mean nurses who look like this. But mostly it will mean nurses (and doctors) who look like this.

    2. Actually, it will mean lots of nurses who look like this. But mostly it will mean nurses (and doctors) who look like this.

  3. Repealing the Family Safety, Security and Transportable Health Care Act will kill people! That’s right. Republicans are killers!

    Also Nazis.

    And crackers, of course.

    1. dont forget fat

      1. Mean killers. Fat, mean killer Nazis.

        Who hate poor people.

    2. Here is a shining example of the return to civility that Democrats like Ms. Lee have been calling for in the wake of the Tucson shootings.

      1. Are you saying I’m niggardly? Are you threatening me?

  4. Two years ago, a federal panel dropped its recommendation that all women begin regular mammograms at age 40 (based on risks and benefits, leaving aside costs). In deference to the ensuing protests, the health care plan mandates coverage of breast cancer screening at age 40 anyway.

    Orrrrr… was the federal death panel’s pronouncement laying the groundwork for the (eventually) single payer system to be able to start cutting back on services that you will be able to obtain? Think about it.

    1. another conspiracy? Either Obama is a calculating genius or an idiot. Have a secret meeting at the Council of Jerk Circles and decide.

      1. Why would I? You’re their best customer!

        1. Oh yeah? Well I had sex with YOUR wife!!

      2. You mean evil genius, don’t you? My money is on the latter option. Actually, evil idiot is most accurate.

    2. Hey Fist, you forgot…breast cancer is not a health issue, it is a WOMAN’S issue. Please!

  5. Inoculation against Obama Care causes Autism!

  6. No replies? No fuck off? No spoofing? Where is every…OMG Obamacare produced zombies. I like it more

    1. Oh fuck! FOE survived the zombie plague

      1. nah FOE was obviously bitten & has only brain stem activity

        1. Ha ha ha ha ha ha ha ha ha ha ha ha!

        2. OhioOrrin, I don’t care if you’re a regular having fun; I’m enjoying the fight. Now let’s kill these motherfucking zombie bitches! 😉

            1. “slurp slurp

              Zombie, are you eating brain? Or are you just incredibly dull and lack any clever talent in replying?

  7. Preventative cannabis treatments for all!

    1. Obamacare turns us into Jamaincan zombies? Hell, I fully endorse it now

      1. Jamaican zombies who can’t spell-a neutral 😉

    1. sheep survived? Libertarian sperm in the ass cures ya boys? This gives whole new meaning to this ain’t going to hurt a bit, sweetie.

  8. Stop ignoring me!

  9. It’s spamarchy!

  10. Rah-thah.

  11. People stop fooling around and get back to work ! My human right to free food, health, housing etc. is not going to be satisfied if you waste time acting like children here.

    1. NotSure, Janet and I are on it.

    2. Did you not get the memo? Only raw brain satisfies zombies.

  12. and to let parents keep children on their policies up to age 26

    I’ve been cheated. I didn’t get to be a “child” when I was 26! I had to be, like, responsible and stuff! I had to actually pay for things I wanted!

    It’s kinda funny to me, though, that folks in the 18-26 year bracket are all children now. The same people who insist on this also believe that these “children” should be liable for conscription either in the military or for “national service” digging ditches for the feds. And here I thought they were opposed to child labor!

    1. Enjoy, why do you hate The New Children (18-26)??

      Yeah – my wife and I were discussing how we GOT MARRIED when we were 23. Fuck, that seems so young. Lord knows how we would have made it for 26 years of marriage (so far) without having every last fucking need want met by the government. I don’t know what we’d have done if we’d have had to work and pay for shit ourselves.

      God Bless Uncle Sugar!

    2. They are children at that age now. There’s no doubt that kids are, in the functional sense, maturing slower. At least in the upper-middle class brat demographic.

    3. You may not realize this but, it doesn’t matter how old you get, you are still your parents child. You can’t get out of it.

  13. or for “national service” digging ditches for the feds.

    Quit lying, Goebbels. We’re on the ditch-fillin’ committee.

  14. Unless your a politician (or an idiot), you recognize the inherent truth in TANSTAAFL.

  15. Unless your a politician (or an idiot), you recognize the inherent truth in TANSTAAFL.

  16. Goddam Mumbai squirrels.

  17. This is about as red as meat can be for libertarians.

    But good luck convincing the rest of America.

    I weep when I read shit like this, because it should be obvious and not even need to be said.

    Baaa, indeed.

  18. Stop infringing on my rights to a “free” lunch paid for by others, damn you. In fact Obamacare should be the first step in a sweeping reform to help enforce all our rights! I also want change to give me free housing, a free sports car, my own game room, free food & drink, access to hot chicks, and the right not to work, cause work is for suckas!

    /sarcasm off.

  19. “The first lesson of economics is scarcity: There is never enough of anything to satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics.”

    -Thomas Sowell

    1. I’m stealing that one. Thanks.

  20. We’ve been on this preventive care/wellness schtick in the health care industry for thirty years now.

    Thirty years marked by skyrocketing costs.

    You’d think by now people would have figured out that preventive care and wellness and all that are well and good, but they are more expensive.

    1. But that’s all cause by greedy people siphoning off profits.
      Put altruistic government people in charge, give back the money lost to profits, and health care will be affordable to all!
      The free market is the problem!

      Never you mind that profit motive results in efficiency, and that government, without a profit motive, is the most inefficient organization known to man.
      Blaming greed feels good!
      It’s those greedy capitalists!
      Put the government in charge, take away profits!

      Don’t think … just feel!

      Then it will all make sense.

      1. Sarcasmic, I’m stealing that.

    2. preventive care is not testing, it is exercise and nutrition and life style.

      1. Then we need government to mandate that everyone has the proper exercise, nutrition and live style.

        Every citizen will be assigned a life coach, and anyone who disobeys will be sent to reeducation.

        Government can fix anything if given enough power.

      2. No, Sue, that’s what goes in the wellness bucket. The preventive care bucket is checkups and testing and stuff.

        Regardless of labels, my point stands: we have been pushing this line for decades, and costs have ballooned. ObamaCare ramps it up to 11. Costs will . . . ?

    3. And we’ve been getting fatter and less healthy, so maybe it’s just been talk, which is cheap.

      The actual causes of rising overall healthcare costs are: technological advancement, prescription drugs, treating chronic disease/end-of-life care, and administrative costs and profits in the private sector.

      Costs for government health services have gone up, but at a slower rate than the private sector.

      The status quo will result in continued cost increases for healthcare. So what do you propose to do about it?

  21. Rectal seek help:

    “A family history of mental illness is common. There is a strong association with abnormal menstruation – amenorrhoea, anovulatory cycles or luteal cell defects.[12] There is much evidence of a link with puerperal psychosis, and there may be an association with seasonal affective disorder.
    The present evidence suggests that menstrual psychosis and menstrual mood disorder (premenstrual tension and its synonyms)?which is not associated with bipolar disorder or abnormal menstruation?are distinct disorders.
    The occurrence of episodes before the menarche, during amenorrhoea and after destruction or removal of the ovaries or pituitary all point to the hypothalamic gonadorelin neuronal system as the site of the pathological interaction with the bipolar diathesis.”

  22. The idea that government-run health care will save money is so strongly ingrained in the Democratic worldview that no amount of reasoning or counterexamples can change it. It reminds me of the Republican — really, neocon — belief in Iraqi weapons of mass destruction prior to the second Gulf war. All evidence to the contrary must be suppressed, and the wrong questions must never be asked. Jonathan Chait, for instance, refuses to ask the question, “Why are Medicare fee-for-service cuts not happening now when they’re statutorily required?

    1. (Set as a reply to the first one because of the robo-nanny refusing posts with two-many links…)

      His piece of a couple days ago was particularly hilaripus, because you can almost see him putting his hands on his hips with phrases like “I’ve written about this a million times, and it’s pretty simple.” Yes, it is, but not for the reason you think. Why should we believe the CBO scoring when it rests so heavily on Medicare fee-for-service (FFS) cuts (to the tune of $186 billion)? He — and the Democrats more generally — refuse to recognize that actual savings equals spending less money on something, which the Democrats (and Republicans, let’s be honest) are loathe under any circumstances to do.

  23. “Catching” cancer before it gets worse is not the “pot of gold at the end of the rainbow”. Preventing diseases in the first place is the real pot of gold. This is why this is headed for disaster; why cure (or prevent) the disease when you can treat it. It’s why everybody and their brother is on some sort of prescription drug for completely preventable conditions. It’s why half of those UNDER 65 have pre-existing conditions (which also are 99% preventable) according to this week’s story. The information to make that happen is out there, just no one wants to listen to it.

  24. After reading just the beginning of the article I stopped.

    What facts lead the author, or anyone else, to believe that any of the HCR is free? I have not seen that stated by either side. So, why are you pretending that it was? By mainstream, not by the fringe lunatics.

  25. This plan has no merit

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