White House staffer Marion Phillips, in an official 'blog post entitled “Facts are Stubborn Things“, requested that “fishy” information about the administration's plans for health care reform be reported to firstname.lastname@example.org, presumably so that White House staffers or the “Organizing for America” mouse army can put out counterclaims.
This is a great idea, on which those of us supporting fixing the health care and health insurance markets instead of applying a duct-tape patch should build. It's quite clear that Obama's advisors and staff and Democrats in Congress are having difficulty spotting fallacious or false claims about health care reform, including about the state of health care and health insurance in the USA. The mainstream press, too, is very slow to see errors of fact or reasoning concerning health care when they come from left-of-center politicians and organizations, and hasn't been helping those smart people in the White House do what's best for the rest of us. Let's do our patriotic duty and report “fishy” left-wing claims to the White House so that staffers may read them, become more familiar, and better advise our Organizer in Chief. Tens of thousands per day is better than thousands per day: report all claims that you see. We can't let them be missed and you can't be too confident that your neighbor is doing his part!
Examples of such claims that one might find:
That higher mean longevity in some foreign states where health care provision or health insurance are more socialized means the USA should adopt a health care system in which the government plays a greater role. The “People in ___(European Social Democracy)___ live to be ___(US longevity + 0.3 years)____ therefore social democracy will make American health care better.” argument.
There has been a long line of research comparing detection and treatment of disease in the US to other countries; findings have generally been that the US comes out ahead in these areas–we still have, in a sense, the best health care in the world–and that differences in the “health care system”–the regulations surrounding health care provision and payment–can't account for the difference in longevity. This isn't even very controversial–it's established fact, and facts, as the White House would remind us, are stubborn.
For a recent example of this research, read Preston and Ho, Low life expectancy in the United States: is the health care system at fault?, a National Bureau of Econcomic Research working paper prepared by two University of Pennsylvania economists. They find the answer to the title's question to be a clear “no”; for conditions where lifestyle does not play a role, the US has experienced significantly greater declines in mortality, and that cancer survivorship is far higher in the US than in Europe.
The claim that adoption of European health care policy will bost longevity to European levels is thus as fishy as homeopathy. Sugar pills won't fix health care in the USA.
That comparisons of US expenditure on health care with that of social democracies are meaningful. We hear often that the US spends 17% of its GDP on health care, usually in conjunction with a mention of the disparity in longevity, but what is actually government controlled spending amounts to but a fraction of this. Comparing the US countries with single-payer or near-single-payer systems is meaningless, no more than it is meaningful to compare a prison inmate's spending on food with a free man's. If that's not reportably fishy, I don't know what is! The meangful alternative is comparison of prices paid for procedures and medications–“bang for the buck”. I suspect that we'll come off poorly; that's why I get my dental work done in Mexico and many people travel to India or Thailand for surgery.
That “health insurance” and “health care” are the same thing. Insurance is supposed to be a hedge against risk, not an insulation against the price mechanism–that it has become the main way Americans pay for health care is a major part of the problem. Any speaker or writer who uses “health insurance” and “health care” synonymously, writes of the uninsured as though they lack access to basic health care, or who refers to “health insurance” as “health care coverage” is likely to not know the subject and is thus “fishy”. Good, patriotic Americans will report such dangerous characters.
That 47 million Americans are involuntarily uninsured. It is very important to distinguish between those who are uninsured because they do not wish to purchase insurance and those who are uninsured because they are priced out of the insurance market, and among those priced out it's important to distinguish between those already eligible for public assistance and those who are not.
This matter has been studied, most famously by the Employment Policies Institute. The finding: The involuntarily uninsured who are not currently eligible for entitlement programs are less healthy than others, but they are only about a quarter of the uninsured population. Report anyone who claims 47 million to be the number of concern to email@example.com.
That “greed” is somehow to blame for high health care costs and high insurance rates and for the existence of the involuntary uninsured. The third-party-payments problem–insulation of buyers from prices–can cause prices to go up, so perhaps there's a kernel of truth to this: if sellers can sell as much at a high price as at a low price they will go to a high price. But that's just an inevitable law of economics, not any peculiar over-and-above “greed”, moreover, that's not where those who favor the “greed” explanation place the greediness. They're talking about greedy insurance companies, not greedy MDs.
Sometimes this is just the “evil middleman” narrative, which collapses the claim into #3 above. Most of the time, however, it refers to specific insurance company practices. Sometimes this is class envy concerning employee salaries, as though insurance-company employee salaries should be set by some other mechanism than that which sets them in other markets. Sometimes it's a reference to the inability of people who are already ill to get insurance. But people who are already ill don't need insurance. They're not at risk of becoming ill. They are ill. They need either wealth, income, charity, or previous insurance and in this last case strong, binding contracts and courts which will uphold them. Asking insurance companies to cover them is asking them to be charities–and it's disregarding the interest of those who are insured and need the insurance company to be solvent and to keep its prices as low as possible given the coverage purchased. Of course, the already ill should be able to purchase insurance for other conditions; the “greed” narrative would have insurance companies not selling them policies due to greed. Not selling something due to greed? Forgoing the opportunity to make a profit due to greed? Ridiculous, and a very fishy claim! Report it, and look to state coverage mandates for the real reason the already ill cannot get insurance.
That our current problems demonstrate that markets cannot possibly provide health insurance and health care.
Party A tells Party B what to buy from him and C pays for it regardless of price: that's hardly a market at all.
The root causes of healthcare and health insurance market problems are well-known: the coupling of insurance to employment, meaning that people do not shop for insurance policies and policy purchase decisions are not made in individuals' best interests, tax policies which favor overinsurance for those receiving insurance from employers, the price insulation or third-party payments problem caused by overinsurance, and the inability to buy cheap policies thanks to coverage mandates.
People need to ask President Obama and the Democrats the tough question: If it were possible to fix health care and health insurance by market reforms alone, solving distributional problems with vouchers, would you support this?
If the answer is “yes”, then this public-option thing, rigged to lead to crowd-out and rationing, needs to be dropped, as we know how to fix health care without it. If the answer is “no”, then we know who's truly fishy. Report them to firstname.lastname@example.org, early and often!
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