Federal Health Care?

A friend of mine sent me an e-mail that included this picture. There was an explanation in the message, but the picture says more.

For my thoughts about federal health care, see my posts on this blog labeled Universal Health Care.

Rand Paul on Health Care

Rand Paul is, for now, better known as the son of Ron Paul. But he's stepping out and deserves attention for who he is. Below is a video where he talks about health care.

This is a bit of preaching to the converted. Libertarians already get it. The challenge for Rand Paul and others is finding a way to explain these issues in soundbites. Sad but that's politics.
His reference to water distribution after Katrina is pretty good.

Universal Health Care and the Doctors

I saw this great op-ed piece in the Wall Street Journal: When Doctors Opt Out. Not sure if the article will stay online. It's by a Dr. Marc Siegel, and he talks at length about doctors refusing to accept Medicaid and Medicare patients. This does not bode well for a government-run universal health care system.

For some of my past posts on this topic, see:

Sept. 2006: Universal Health Care - Looming Catastrophe

Dec. 2006: Universal Health Care Again - Do Doctors Make Too Much Money?

March 2007: Socialized Medicine

Ted Kennedy and Universal Health Care

I've been scratching my head about the Ted Kennedy brain surgery thing. Here's a guy from Boston who works in Washington DC. New York City is in between the two. And he goes to North Carolina to get the surgery done.

It's my impression that both Boston and New York City have outstanding doctors. Not that they're all great, but there's plenty of good ones. Some people in the Albany area will go to one of these places if they have a serious medical problem. I remember my dad going to Boston when he had a brain tumor. I'd guess that the Washington area also has some pretty good docs.

So why does Kennedy go to Duke? I'm guessing that Doctor Allan Freedman is the best brain surgeon in the whole world, and it's not even a close call. We can all respect Ted Kennedy's desire to have the best.

A bigger issue is what this says about universal health care, one of the great challenges we supposedly face these days (if you're listening to national politicians anyway). Our current medical system has a variety of things going on: Medicare for seniors, Medicaid for the poor, mostly private health insurance for most people with jobs, and a big chunk of people with no insurance.

Oh, and there's one more ... the congressional health plan. That's where congressmen and senators get to go to the best doctors in the world, skipping ahead of everyone else waiting to see them, and the taxpayers pay for the whole ride. I'm betting Kennedy didn't have to pay a copay or deductible for his surgery.

So here's a simple proposal for any universal health care plan. Make sure that members of Congress and the Senate have to be in that plan. They get the same deal as the rest of us. Yeah, that'll be the day.

Universal Health Care - one more time

I've mentioned universal health care at least a few times before, most recently in a post about Socialized Medicine. In the last few days I caught a bit of a Democratic presidential debate where universal health care was discussed in some detail. I also have read a bit about the plan put forward by Hillary Clinton, as well as Mitt Romney's proposal.

Here's what seems to be happening now. Universal health care proposals are no longer universal. In the latest proposals you can choose to stay on your employer's plan. Others will be covered by the government (mainly the poor and the elderly). And some will be required to buy health insurance, though I don't understand how this will be enforced, and suspect it won't be.

I'm guessing that many employers would see this approach and gut their health plans as much as possible. As long as you have coverage for something, then you are in and they can escape by saying they do provide health care. Sure your co-pay is now $100 and your deductible is $5,000, but you're covered so it's all hunky dory now.

Meanwhile, I'm still waiting for my government cheese.

Socialized medicine

I attended a talk tonight where the speaker discussed health care rationing. Underlying the entire talk, and explicitly mentioned at least once, was the notion that health care is special and should not be subject to the crudeness of market forces. The speaker plainly supports socialized medicine and I do agree with him that we currently have a poorly planned out system of socialized medicine already. We differ on the remedy for this problem. He favors a better system of socialized medicine, where rationing is openly discussed. I favor eliminating (or at least dramatically reducing) socialism in the health care system.

Before I go on, this is related to a couple of posts I've done before on universal health care.

I get particularly irritated by this notion that health care is special, an argument we also see with education. The idea is that health care is so important, and so fraught with problems, that it cannot be left to market forces.

Why is health care so important? Let's consider some theories.

Without good health care you'll die.
-- Without food you'll die. Therefore food is special and should not be left to market forces. We all get government food because we can't be trusted to make our own decisions about food. When I debated Congressman McNulty and raised the food comparison, he actually advocated providing free food to all, saying it as if I was some barbarian who wanted to deprive the poor of food.
-- The leading cause of death among males age 16-25 is car accidents, and car accidents kill a lot of people in all age groups. Therefore cars are special, and should not be left to market forces. The government should provide everyone with Volvos (or pick your favorite "safe" car company) equipped with 6-point harnesses, and people should be required to wear helmets while in cars.
-- Homelessness is really bad for people. Housing is special and should not be left to market forces. The government should provide housing to all.

My point is that you can make the argument for just about anything being special. The "special" argument is utterly empty.

Moreover, the "special" theory completely fails to explain why socialism will do a better job than capitalism of allocating the relevant scarce resources. I inquire of my faithful readers whether they would want the government to control the market for cars, food, housing, or computers. Cars? We'd all be driving Yugos within 10 years. Food? I waver between whether cheeseburgers and other delicious "bad" foods would be banned by the health Nazis, or if the agriculture lobby would manage to get quotas of their products established so we'd be eating even more corn-related products than we do now. Computers? I can barely type on that one.

One of the big rationales on health care from the "special" camp is the concern that those poor uninsured and underinsured folks will be unable to get health care. I raised an apparently ineffective point in regard to that. The poorest person in America today gets better health care than the richest person got 50 years ago. My point is that if the poor today aren't getting the best health care, so what? If they're doing better than the wealthy were 50 years ago, then they're doing pretty good.

But anyway, so what if they are unable to get health care. In this fantasy land, wouldn't the same people be unable to get food, housing, safe cars, etc? Shouldn't we make sure that the government provides them with all of these things?

I have little doubt that if the speaker tonight were made dictator of the US health care system, he would probably set up a better system than the one we have now. But socialism doesn't work that way. First of all, the system gets set up by a political and bureaucratic process that is what created the current system, so giving that process even more say over the system is likely to make things worse, not better.

Second, why do so many people reject capitalism? It's the best system out there for just about everything. You want a system where the decisions take into account the personal feelings and desires of the people involved? Then give the consumer the power to make their own decisions and restore the market incentives to allow them to do so. You want an efficient system? Capitalism drives efficiency better than anything else. Government control has never been considered efficient.

I know, I know. It's not fair. Easy for Warren. He's a rich lawyer. He can afford to pay for his own medical care.

True. But I can also afford to eat out a lot (I do - way too much), to drive very safe cars (I do, but our newest car is now 5 years old with almost 100K miles on it), to live in a particularly nice house (I do - but it's not a McMansion or anything), and even to send my kids to private school (no, at least not yet - I'm not that rich).

So why isn't all of that unfair too? Come to think of it, I even get to take nice trips to interesting places, including a recent trip to the Bahamas. Maybe the government should provide free vacation travel to the poor too.

No way. The thing is, capitalism works. It maintains incentives for individuals, making our economy run more efficiently and growing the pie so there's more for everyone. Socialism removes incentives, devastates the efficient functioning of the economy, and destroys growth.

The problem with health care today is not a lack of socialism, but rather too much socialism.

Unfortunately, it seems the vast majority of voters buy into the "special" argument. Our education system and popular culture completely reject the benefits of capitalism. I'm not optimistic about our future in this regard.

Universal Health Care again

I posted a while ago about Universal Health Care. A friend and I were chatting last night about it and that motivated me to discuss it again.

A couple things he said got to me. For one, he said something like "40 million people in this country don't have access to health care." This is rubbish! (I used to have British friends ... but then they got to know me better.)

The much-touted 40 million uninsured do have access to health care. They have to pay for it. My insurance doesn't cover the cost of lunch at McDonald's, but I still have access to it. I can walk into McDonald's, slap down a couple bucks, and eat a meal with a lot of calories. Similarly, anyone who is prepared to pay cash can get an appointment with a doctor and pay for the care.

Oh, but they can't afford it!! Yes they can. People who can't afford it qualify for Medicaid. And we should all pay attention to Medicaid, because many doctors won't accept Medicaid patients and some say the ones that do accept it aren't all that great. We should notice this because Medicaid is the clear model for what universal health care will be.

Getting back to last night's chat, I asked my friend how doctors would be paid in a universal health care system. Who makes that decision? And what guarantee do we have that the doctors won't decide to go into another line of work when we stiff them on reimbursement?

Another friend of mine is a doctor, and he's always talking about finding another way to make a living. He works long hours and makes good money, but he sees reimbursement rates being reduced every year, and thus his income looks like it will go down. So why should he bust his hump for that?

In last night's chat, my liberal friend cast this doctor income issue in the context that doctors make too much money and that a system that reduces their pay wouldn't be a bad thing. Really? Tell them that. From what I read, many doctors make somewhere between $100K and $200K. Not too shabby, but these are very talented people who work very hard. Many of them can find other ways of making money and might choose to do so if government screws up the health care system to bring doctor pay to a "fair" level of $100K or less.

I'm waiting to see a politician come out and say that doctors make too much money. You better hope you don't get sick after you say that in a campaign. "Senator Smith ... nice to see you. We've got some great medicine for you."

Universal Health Care: A Looming Catastrophe

People frequently ask about my position on health care. The incumbent in my race, Mike McNulty, advocates "universal health care." This is a popular idea. It's also dangerously wrong.

--Update: Most recent post on this blog about Universal Health Care and Doctors--

When I'm asked about this idea, I often respond by asking: "Why not universal free food, or universal free housing, or universal free clothes?" Why is medical care so special that we need the government to provide it for us?

Universal health care would be the final nail in the coffin of capitalism in health care. The Left probably cheers at this metaphor. They'd like to end capitalism in every area. A conservative friend of mine mocks the liberal position as: "The government should give everyone a million dollars, make everything free, and then we can all go dancing in the fields." You're supposed to flap your arms up and down when you get to the dancing part. He's a really funny guy, perhaps the funniest in Fulton County (and that's saying a lot).

Universal health care is socialized medicine. Period. That's what it is. If you support universal health care, then you do support socialism. You reject capitalism. Fine. If that's your position, then say it proudly. Don't hide behind phony taglines like "universal health care." Call it what it is -- socialist health care.

So this is really the battle between capitalism and socialism, but conducted with proxy metaphors. I'd like to say this is a war between Democrats (for socialism) and Republicans (for capitalism) but the Republican Party and its leaders have been caving in to socialists for so long that it's just a question of where they want government in charge. The Medicare Prescription Drug program was Bush's plan, and it's just socialism. It's actually quite a good example since it's highly bureaucratic and the rules are so complicated no one can figure them out. That's what socialism does for you. If you think big corporations will screw you, imagine how much worse it will be when the government's in charge and has no competition.

As a personal injury attorney, I've had a few Canadian clients and I see what they go through. One guy had a head injury and was having symptoms that seemed consistent with a possible brain injury. I kept telling him to get a CT Scan or MRI of his head. I figured the Canadian system might make him wait a while, and encouraged him to drive into NY and pay for it himself. He hasn't done that yet, and so far Canada is refusing to let him get a scan there. Another client got cut off from physical therapy after three weeks. I don't have that many Canadian clients and I have two solid stories like this.

One of the fundamental underlying problems is a misconception of the word "insurance." We hear about so many people not having health insurance. Universal health care is touted as a solution to the problem of the uninsured.

But what we call "health insurance" is far more than that. It's really a medical payment system masquerading as insurance. We buy insurance to protect ourselves from sudden, unexpected losses. Consider car insurance. It covers accidents. Usually we use car insurance when our car is damaged and it'll cost a lot to fix it. We don't buy car insurance to cover routine oil changes.

So why should health insurance cover your annual physical? Health insurance should be for the rare events, like when you need heart surgery for $50K. If it covers routine things, it's not insurance anymore.

If you go to your primary care doctor once a year, that would only cost you about $100/year. If you had a few visits a year, maybe you'd spend $1000/year. But health "insurance" costs a lot more than that. My family of four spends about $13,000/year on coverage through COBRA from my wife's previous employer. We have some unusually high medical expenses, but I doubt our visits cost more than $5000/year.

There is an approach growing out there now called "consumer-directed care", commonly meaning a high deductible along with a "Health Savings Account" where you can pay for the routine stuff with pre-tax dollars. along the lines of how I started this riff, I wonder when we'll get tax-advantaged accounts for food, housing and clothing. How about a "Fitness Savings Account" so we can join a gym with pre-tax dollars? But i digress. The HSA approach is a lot more like what insurance really is. My family will be moving to that kind of policy next year, if not sooner.

I can imagine the criticism: "But Warren, you're rich. What about those poor working families who can't afford to spend $4000/year on routine health care?"

My response is simple. How much do they spend on food, housing and clothing? That's gotta add up to more than $4000/year for a working family of four. Why don't we give them that stuff for free too? Aw heck, let's just give them all a million dollars, make everything free (start flapping your arms) and we can all go dancing in the fields ...