Obamacare

Are Conservatives Unintentionally Ensuring Greater Government Control of the Health Care Sector?

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Over at The Washington Examiner, Philip Klein has a smart column urging Republicans to focus their energy on constructive health policy solutions rather than simply fighting to repeal ObamaCare. One of the points he makes is that opposition alone leads to greater government involvement in the health care sector:

Conservatives' neglect of health care policy virtually ensures future increases in government control.

Even before Obamacare passed, the United States did not have anything close to a free market for health care. The repeal of Obamacare will not create a system in which individuals have more choice over how to spend their health care dollars. Rather, this will require proactive steps to unravel the layers of government policies that distort the market and drive up costs.

One of the most effective arguments Democrats had during the health care debate was that Republicans didn't address the issue when they had full control of the government. And if Republicans fail to offer a compelling alternative during the 2012 campaign, Obama will argue that we cannot go back to the pre-Obamacare status quo.

Even if Republicans win this current battle and repeal the law, we'll still be left with a mess of a health care system. If Republicans don't fill the vacuum with solutions of their own, liberals will return with a vengeance to impose their own ideas, as soon as they return to power. By that time, the crisis will be so severe that the measures they'll take would likely be even more drastic than Obamacare.

It's the same problem that persistently plagues entitlement reform. Why is it so hard to reform Medicare? In part because expensive entitlements are inevitably popular and therefore politically resistant to change. But in part because Republicans haven't made a strong, concerted case for changing it. They've waffled, avoided talking about it, and generally tried to change the subject whenever possible. Indeed, members of the GOP spent much of the ObamaCare debate criticizing Democrats for making big cuts to Medicare. And this year, the conservative wing of the party put forth a supposedly-radical plan to require a balanced federal budget—and exempted the single-payer-for-seniors program from its spending caps

When it comes to health care, Republicans are clear enough about what they're against. But most don't seem to know what they're for. So when the public eventually demands action, or when the political moment arrives to make big changes, they're outflanked by Democrats with plans in hand. Opposition alone offers an easy-enough path to short-term victory. But it doesn't offer much opportunity for long-term progress. 

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  1. If they go after Medicare or SS they’ll get pummelled in elections and the Democrats will make health care policy unilaterally.

    While the GOP is largely chickenshit on this issue, the root problems are:

    1. Advances in medicine make it possible to save lives heretofore unsavable, and reduce pain and disability heretofore irreducible…for a huge price.

    2. People don’t like to die or be disabled and they also don’t like to spend money.

    3. Govt intervention in the health care market is the status quo, and has been for a long time with few problems visible to the average citizen.

    These combine to make people both in favor of govt intervention AND skeptical of claims that govt intervention is harmful.

    Let me know when you have a solution.

    1. Point 3 is especially insidious. Most people have no idea how unfree the health care market is. And to the extent that they are aware of this situtation, they do not see it as a problem. They think that we would be lost without medical licensing, the FDA, the CDC, patent system, and so forth.

    2. Re: Tulpa,

      Let me know when you have a solution.

      Here it is, spelled for everyone:

      D-E-F-A-U-L-T

      It is inevitable – there WILL be default, and instead of a few people crying about the end of Medicare as “we” know it, there will be many crying about the end of Medicare in total.

      The other solution is to have a Congress and President not keen on reelection but in phasing out these unconstitutional programs, but that’s even more fantastic than a Congress willing to patch up Medicare.

      1. There’s a lot of adverse side effects from the economy collapsing. And for the reasons I give above you can be sure that nothing short of the economy collapsing will end Medicare and SS.

        1. Re: Tulpa,

          There’s a lot of adverse side effects from the economy collapsing.

          No shit. What are you going to do about it? You can’t go against the laws of economics, no matter what you wish for.

          1. Dude, what’s your beef? I’m just pointing out that “default” isn’t a solution. Indeed, default is the problem that we’re trying to avert.

        2. The government going into default does not equal “the economy collapsing”. One could argue it would actually help the economy by making it harder for the government to obtain the funds it uses to strangle economic activity.

      2. No default, in terms of actually missing a scheduled payment. Instead we will pay the Chinese back with worthless paper money.

        1. no, since the chinese continue to buy dollars to reduce the yuan’s value & spur exports.

          1. Giving American consumers an increased standard of living as they are able to purchase more for their buck.

          2. Re: Double Asshole,

            no, since the chinese continue to buy dollars to reduce the yuan’s value & spur exports.

            Sure, like the Chinese could play that game forever.

            The economic genius, Double Asshole, has spoken.

        2. Re: DEM,

          Instead we will pay the Chinese back with worthless paper money.

          DEM, that’s a default. Money serves as a medium of exchange, but what is being exchanged is production. If you produced the equivalent of 100 coins of gold but only pay a debt of 100 coins with 95 coins, you’re defaulting on your debt.

          1. Default is a failure to comply with the payment specified in the debt agreement, so paying the debt with worthless dollars is not default if the original agreement specified dollars as the unit of payment.

            The dollars I used to pay back my student loans were worth significantly less than dollars were when I initiated the loan; that doesn’t mean I defaulted.

            Obviously there’s a different dynamic when the entity you’re loaning to has the power to control the value of the repayment, but that’s a classic caveat emptor situation.

            1. Tulpa has it, though of course, the lender will see intentional devaluation as a default, as they should. But strictly speaking, default is missing a payment.

        3. Just like the Germans did post WWI.

      3. Not default. Devaluation.

    3. To boil it down, the Democrats’ argument is: vote for us and we will give you free shit. Conservatives can respond with all the principled, free market-based ideas they want, and most people will think, “when are they going to offer me free shit?”

    4. My solution to the entitlement problem is to link entitlement funding directly to taxes.

      Replace the current SocSec and MA payroll withholding tax with a new “Transfer Tax”, set annually at a rate which fully funds all federal transfer/entitlement/redistribution programs (Social Security, Medicare, Medicaid, unemployment “insurance”, whatever else you got).

      100% of the Transfer Tax would be paid by the employee.

      As the costs of these programs escalate, so will the tax. This does two things:

      (1) It gets rid of the “unfunded” liabilities that overhang the federal balance sheet.

      (2) More importantly, it actually informs people that these programs aren’t freebies, that increasing benefits will cost them personally, and cutting benefits will benefit them personally.

      Now, we’re ready to have a real political discussion about entitlements. And you have a constituency which is prepared to be skeptical, at a minimum, of these programs.

  2. When it comes to health care, Republicans are clear enough about what they’re against. But most don’t seem to know what they’re for.

    Oh, many (including me) have known what the Repubs are for when it comes to healthcare: NOT a free market. Period.

  3. Representative Paul Ryan isn’t a conservative? Is Philip Klein fucking kidding me?

    So his plan and the fact that most of the republican put their necks on the line by voting for it has already vanished down the memory hole. I guess some people can’t remember anything that happened earlier than last week.

    1. Not to mention his entire premise is basically saying that the GOP shouldn’t strike down Obamacare unless they have something better.

      Yes the status quo sucks, but as bad as it is, it is still LIGHT YEARS preferable to the consequences of Obamacare.

      One does not need to cut off ones nose to spite ones face.

    2. That was a Medicare voucher plan, but it did nothing about the health care system outside of those over the age of 65.

      1. The people under 65 cost the system peanuts compared to the people 65 and over.

        1. Right, but Obamacare is intended to address the 65 and under crowd. One of the points is that people despised the old status quo and wanted people to do “something” to fix the system. The critique was that Republicans didn’t offer anything, so at least Obamacare was something.

          The criticism of Republicans on entitlements like Medicare was that they are schizophrenic on the subject. During the Obamacare debate, they were harping on cuts to Medicare and now they’re upset that the Dems are politicizing their cuts to Medicare (Ryan’s plan being one of them).

  4. Say oil changes were covered with car insurance with a $5 copay.
    How much would they cost?
    $50? $100? $200?
    What would you care? You’re not paying it directly. You have no reason to shop around.
    Say they cost $100, and your insurance covered one a month.
    How much would your insurance cost?

    Lets get the government to force car insurance to cover a wash and wax every month. Don’t forget the undercoat. Add a detailing in while you’re at it. Can’t drive a filthy car, can you?

    What would these services really cost now that a third party is paying?

    What would car insurance cost?
    It’s easy to imagine car insurance being totally unaffordable at this point.

    So government blames the greedy insurance companies and the people demand ‘single payer’ to “fix” the problem.

    Yeah.

    That’ll fix it.

    1. Oil changes don’t prevent an auto insurance claim, so there’s no reason for the insurer to cover them. If you don’t get the oil changed and your engine blows, the insurance company doesn’t care.

      Preventative medical checkups can prevent a larger medical claim down the road, so there is reason for the insurer to cover them.

      1. Obviously you missed the point.

        1. No, just noting that your point missed a larger point.

          1. Only the point on the top of your head.

            1. sarcasmic is correct; health insurance has to become more like car insurance. 90% of all health care spending is third party, and I believe taxpayers pay 55% of that 90%. Insurance for catastrophic events, and self fund the smaller stuff. Doctors are the only guild left that don’t compete on price – competition works in every other market, why wouldn’t it work with medicine?

      2. “Preventative medical checkups can prevent a larger medical claim down the road, so there is reason for the insurer to cover them.”

        Theoretically, yes, but the research on whether or not they actually do isn’t really showing it.

        1. Here’s what the doctor and patient are thinking during most preventative medical checkups:

          Doctor: Jeez, you are fat. If you stopped eating so much, you might avoid heart disease.

          Patient: Ah, screw you. I want to eat like a pig, it’s your job to cure me if I get heart disease.

          Doctor: Would you at least consider exericing?

          Patient: Screw you.

          Doctor: But heart disease will be expensive to treat.

          Patient: Not for me, sucker!

          1. The obesity nagging crap isn’t what I had in mind, for reasons that would be obvious if you met me in person. I was thinking of detecting problems in an early stage of development when they can be easily treated without any willpower use by the patient.

            1. I was thinking of detecting problems in an early stage of development when they can be easily treated without any willpower use by the patient.

              So far, it looks like running lots of expensive tests on asymptomatic patients doesn’t really save enough on the back end to make it a net win.

      3. Medical checkups don’t prevent anything if the patient ignores the doctor’s advice.
        Doctor tells the patient to change their diet and the patient doesn’t change their diet. What did that prevent?

        I do believe that at some point our government will decide that it can cure preventable illness by making it a criminal offense to disobey a doctor’s advice.

        1. I was thinking more of checkups where medical issues are discovered before they become more severe. Like finding a lump on your balls early enough that they don’t have to castrate you.

          1. I check my testicals for lumps several times a day. And I encourage my friends to have me check their testicles too.

          2. The treatment for a solid testicular mass is orchiectomy, whether it’s found early or not.

      4. I think the claim that preventive care saves money is bogus, and not backed up by actual data. Why? Not everyone who gets preventive care would actually go on to develop a disease–you are treated if you are “at increased risk”, not for actually developing the disease.

        What happens in reality is that people “at risk” for certain diseases are given extra tests, medications many of them do not need (e.g. statins) etc. Many of them would not in fact develop the disease if untreated, so all that care is wasted on them. Many others develop side effects from the intervention itself (see statins again) which need to be treated. And if you prevent a heart attack or stroke at say age 70, the individual in question may die of Alzheimer’s at say 80 or 85. Which is a more expensive death?

        We need to let go of this shibboleth that “preventive care saves money.”

        1. Preventative care makes money for caregivers and drug companies.

          I would think the egalitarians would be squealing like stuck pigs at the idea of transferring all this wealth to rich doctors, rich chemists, and rich drug company executives.

    2. We can mandate oil change coverage so long as we have a panel of automotive experts set standards for effectiveness and then impose price controls — say, $25 per oil change. Voila, problem solved. Right?

      1. Yep. Then the people who do oil changes form a lobbying group that goes out and gives money to politicians in exchange for them urging the experts to raise that price. After all, these poor people can’t live on twelve bucks an hour. What kind of a living wage is that? And what about benefits? They can’t get full benefits if they can only charge $25? And they can’t just let any shlub change oil. They need to be licensed with stringent requirements. Next thing you know that $5 copay costs the insurance company a hundred bucks.

        1. Next thing you know that $5 copay costs the insurance company a hundred bucks.

          I’m pretty sure the insurance companies aren’t losing money – Not sure who eventually pays – probably the rate payers and taxpayers.

          But you’re entirely correct about the disconnect between rates and consumers.

          That is why healthcare is all over the place.

          One more thing – you forgot to mention the added costs of the lobbying group and the panel of ‘experts’.

          1. I’m pretty sure the insurance companies aren’t losing money

            Because they raise their rates when that $25 oil change becomes a $35 oil change, again when the board determines the price should be $40…
            Eventually when the premiums become unaffordable, and nobody is willing to pay $100 out of pocket for an oil change, the government blames the evil profit-mongering insurance companies.
            More regulation and eventual government controlled single payer becomes the solution to the high cost of auto care and insurance.
            (meanwhile it still costs $100 for a $20 oil change)

      2. That’s how car insurance works. Insurance companies set a fixed price that they will pay for parts and labor for repairs and tell the mechanics those are the fees they will pay for them, period.

    3. The $100 price point is not bad at all depending on the type of system you’re talking about. If you have a V8 with an 8-10 quart system that requires full synthetic you’re looking at $40-$50 in just oil, plus a $20 filter if your filter is a dealer only part, plus time and labor.

  5. Back when Republicans held power, I was active in NFIB. They tried time after time to get something as simple as making insurance available across state lines, but Congress has no interest in pushing it. GWB and the Republicans had a prime opportunity but once again wasted it. So yes, they are good at saying NO, but shitty at supporting better ideas.

  6. Even if Republicans win this current battle and repeal the law, we’ll still be left with a mess of a health care system. If Republicans don’t fill the vacuum with solutions of their own, liberals will return with a vengeance to impose their own ideas, as soon as they return to power. By that time, the crisis will be so severe that the measures they’ll take would likely be even more drastic than Obamacare.

    No kidding. Single payer, here we come.

    There will be no significant alteration of the business plan of the doctors’ union, just an infinite pool of government money.

  7. Why on earth would anyone suppose that conservatives would want to reduce the involvement of government in health care? The evidence is starkly against any such assessment.
    Face it, the worst predations against individuals originate in government actions by conservatives [who ordered wage and price controls?].
    The two parties are the incubus and succubus of evil — regardless of who’s in charge, you know you’re going to get intercoursed.

    no hugs for thugs,
    Shirley Knott

    1. “[who ordered wage and price controls?].”

      I know! I know!

  8. Obviously you missed the point.

    By a wiiiiiiide margin.

    1. Questioning unspoken assumptions != missing the point.

      1. My point was to illustrate how costs can get out of control in a third party payer system.
        A point that you apparently missed or ignored.

  9. These are just faux conservatives, indistinguishable from the left, save for a few minor details.

    1. They’re not faux conservatives. They’re defending the status quo, which is what conservatives do.

  10. This might help the government discharge its obligations to bondholders, but worthless money will not help the government provide medical services to seniors (or much else).

  11. Previous comment was meant to be a response to DEM about the option to default.

  12. Bring back: Lone Wacko.

  13. Hire: Jack Shafer

    1. Is this like Fuck, Marry, Kill? If so you need a third. In this case perhaps Fire, or Ban?

      1. Ban: Rectal’s new persona.

      2. Good point. A 3rd shall be added!

  14. And they can’t just let any shlub change oil. They need to be licensed with stringent requirements.

    Don’t forget the rigorous, expensive and time-consuming certification process for oil-change approved oil. Or the incessant churning of the patents.

  15. Conservatives’ neglect of health care policy virtually ensures future increases in government control.

    uhm. Is it possible that this isn’t exactly an accident?

  16. Questioning unspoken assumptions

    I believe the primary assumption in the oil change example is this: Costs which are concealed from the end user lead to overconsumption and inefficiency.

  17. Perhaps that would be better stated as-

    WHEN actual costs are concealed from the end user…

  18. Are Conservatives Unintentionally Ensuring Greater Government Control of the Health Care Sector?

    Unintentionally?

  19. Here is my alternative for the under 65 crowd:

    Instead of forcing insurers to take people with pre-existing conditions, forbid them from dropping people who are already sick, or raising their rates.

    Moreover, any illness that develops while you are covered, should remain covered for the long term, even if you switch insurers. The insuer simply has to pay out a lump sum or pay off the next insurer to take you.

    This would resolve 90% of the problems due to people who lose their job and then can’t get insurance. The only people missing out will be those who didn’t buy insurance or get employer-based coverage in the first place.

    Otherwise, let insurers charge risk based rates for new customers. The older and sicker you are, or the longer you wait to buy insurance, the higher your premiums will be.

    1. That wouldn’t resolve as much as you think. Next year, the risk-based premium of the sick patient will be so great that it’d be cheaper to pay out of pocket. And if it’s not risk-based, the insurer goes broke insuring the sick person for the 2nd & subsequent yrs. of their illness.

  20. OK, here’s is my alternative for the under 65 crowd:

    Buy insurance with whatever terms and conditions and benefits you want, at the price charged by the insurance company.

    Be responsible for knowing what you bought, and for enforcing the terms of the contract on the insurer.

    Or not. Be an idiot if you want. But don’t come whining to me with your hand out if you make stupid decisions and they bite you in the ass.

    1. “don’t come whining to me with your hand out if you make stupid decisions and they bite you in the ass”

      Stupid decisions like cancer.

      1. He means stupid cdecisions like buying an insurance policy that allows them to drop you when you get too sick or raise your rates.

        Unfortunately, he’s not taking into account the fact that most people do not negotiate their own insurance policies, they are induced (through tax incentives) to take whatever plan the employer provides.

        Personally, I PLAN to try to negotiate for higher pay in exchange for buying my own insurance. But I have to admit there are very strong inducements to opting into the employer-based plan. Even though I know that I will lose coverage later if I change jobs, and I’ll be shit out of luck if I have a pre-existing condition by that point.

    2. That would be fine if most insurance right now was being bought in the individual market.

      The problem is the vast majority of insurance policies are employer-based. Which means the individual has no control over the terms and benefits – the employer does. And the employer has no incentive to make sure that the insurance policy covers you after you leave the company. Even if you leave because you got too sick to work.

    3. The whole problem would go away if people were rich enough to afford “whole health insurance” the way they can buy whole life insurance, i.e. a policy that you own, paid off or guaranteed rate, for the rest of your life. Eventually people in general will be rich enough to afford that, but it’ll be a long time in the future at current rates of economic growth per capita.

      Unfortunately in the meantime all people can afford is term health insurance. And as risk changes year to year, it becomes a bad deal the year after you develop a chronic illness.

  21. “unravel the layers of government policies that distort the market and drive up costs.”

    That has always seemed a strange position to me given that many nations with much more and direct government control/intervention over health care seem to have lower costs.

    1. given that many nations with much more and direct government control/intervention over health care seem to have lower costs.

      “The service is great, if you don’t mind waiting.” – Comment from a Canadian friend.

      Unfortunately, there are only a few developed countries with a small population relative to their natural resource wealth that can play this type of game. At other scales and levels of development, it gets ugly fast.

      What is actually a strange position is to pretend that the same forces that allow immigrant gardeners to possess cell phones and data plans would somehow not work if applied to health care.

  22. As for what should be done, it strikes me as really simple, you means test this stuff so only the truly needy get it.

  23. Opposition alone offers an easy-enough path to short-term victory. But it doesn’t offer much opportunity for long-term progress.

    Could it be because long term progress, at least on this subject, is impossible?

    I looked around a while back and concluded that socialized medicine is inevitable — that the best that can be done is to stall its implement’n in the remaining parts of the world that don’t have it yet long enough for the people to become rich enough to afford it.

  24. Mr. Suderman has, as most Republicans do, failed to even acknowledge the one compelling and unwavering reason that Medicare is “so hard to reform.” If he and his party could answer this one question clearly, in detail, with good research backing it up, they might get somewhere. The question is this: What happens to me?

    Republicans seem to think that the millions of seniors who depend on Medicare and the people who rely on Medicaid for what little health care they receive somehow have stashes of cash that they’re hiding away that they COULD use to pay for health care if only the “entitlement” programs were done away with. As a 55-year-old woman who has paid in to Medicare since I was 16; who has worked in non-profit organizations my whole life and never made more than $34,000 per year; and who now has five chronic co-morbidities that require multiple trips to specialists that are not happening because my “gold standard” BCBS insurance co-pay for one visit is half my weekly food budget, I can tell you that even if Medicare still exists when I hit 65 (if I live that long), I will not be able to afford the 20% of cost it doesn’t cover (I’m sure it will be 40% by then). What am I supposed to do? What are the millions of people like me supposed to do? Just suffer and die? Resort to emergency room care and then medical bankruptcy? There is only one solution to the health care problem in this country and it would be so good for business and the economy that I’m bewildered that more Republicans don’t support it. Single-payer health care is the answer. Higher taxes? You bet – and I for one would much rather pay 4.75% more than I do now and never have to worry about helath care access again than the 10-20% of my income I now pay for premiums, co-pays, deductibles, co-insurance, and whatever BCBS won’t cover, not to mention the health benefits of NOT having to fight for the tests, treatment, and drugs my doctors recommend. So quit the alarmist BS about “government-controlled” health care. So what? If Republicans are going to require me to give up more and more in order to decrease the deficit while the super-rich just sit on their mountains of dough (except, of course, for the piles they shovel into campaign funding), I’d like to actually GET something for my money!

    1. I for one would much rather pay 4.75% more than I do now and never have to worry about helath care access again…

      Don’t forget your mortgage and car payment too! That Government stash is bottomless!

      But then again you won’t have access, because the same people that have mucked up the system by misallocating the resources to their crony friends will do so at an even quicker pace if they are the only game in town.

      You write this comment on a computer without ever figuring out that the only reason you didn’t need to wait in line for time on a mainframe to make said comment is that the computer industry has been relatively unregulated. But of course, healthcare is different.

      And you’re right. Healthcare is different, in that people will gladly pay for the latest innovation in healthcare if their lives depend on it. Much more so than computers.

      Yet, strangely there’s no computer crisis. What could possibly account for all the problems.

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