Tuesday, September 11, 2007

WWRAS (What Would Ruth Ann Say)?

2PJ’s seem to have started a regular feature of reviewing Jack Kelly’s Sunday columns. I have no such plans with regard to Ruth Ann Dailey, but I do reserve the right … *ahem*, maintain the prerogative to comment on her columns when they really cry out for it.

Her latest effort almost reaches a degree of fairness, but in the end she has to be true to her conservative roots. She is discussing health care, and in particular bashing, albeit somewhat uncomfortably, the Pennsylvania Council of Churches call for a single payer health insurance plan. For example there is this paragraph:

“The council's essay also contains an inadvertently funny claim: that a single-payer system would lead to "efficiencies." This would indeed be a miraculous event of divine proportions, as a government bureaucracy has never, in all of human history, delivered any private service more efficiently than the free market.”

Which she follows with this sentence: “Not that what we have right now is a truly free market” Instead of expanding on that, however, she goes back to the ‘40’s to explain the origins of health insurance: a work around for government “foolish” wage controls.

Her whole column concerns the notion of what Jesus might want in the way of health insurance/health care. Uncomfortable with having Jesus advocate naked free market greed, Ruth Ann focuses in the other direction, discussing the inefficiencies of government.

Except that she doesn’t, really. She doesn’t explain the remark about us not having a free market in health insurance/health care, and she seems to think that just saying government is inherently inefficient is sufficient. Fool that I am, I would like to rush in where Ruth Ann was hesitant to tread.

She claimed that some at the Labor Day parade opposed the Single Payer notion, although she had just one quote: "That's not going to be an easy sell … Smoking, overeating -- some of the most expensive health problems out there -- are to some degree self-inflicted," she said. "Who wants to subsidize someone else's bad choices?"

Except that we all do that now. Fat people and smokers still seek health care. Actually, if they can’t pay they probably wait until they need the more expensive treatments, and go to the emergency room, driving up (written off) costs when they don't pay. If the woman Ruth Ann spoke to has health care at work there are probably fat people or smokers there, driving up the group plan rates as the health insurance company decides that maybe working people aren’t such a good insurance risk.

The broken part of the health insurance/health care system comes in several parts. The insurance system spent far too long not questioning doctors and paying whatever they said something cost. Now there are “managed care” controls, but the pressure is still on doctors to over-charge. The new controls, such as paying a guaranteed 80% of what is a usual, customary and reasonable charge in a particular region (as detirmined by the insurance company), encourage doctors to explicitly or implicitly collude in raising prices, to maintain their income. And then there are prescription drugs, the variety of which proliferate tremendously and so are poorly understood by doctors. They are priced to recoup “research” costs, which costs are actually dwarfed by the cost of the relentless advertising pharmaceutical companies bombard us with. And of course the hospitals have to get in on the health insurance gravy train, with their precautionary diagnostic tests that, absent health insurance, cost as much as a small automobile (the things that nobody drives any more).

Most of my ideas about government efficiencies come from Paul Krugman, whose economics I feel more comfortable than his politics. He points to the pure government parts of Medicare, and the VA during the Clinton years.

Clearly a Single Payer plan would need to immediately limit the growth of physician salaries to no more than the rate of inflation. Pharmaceutical companies would now be negotiating with one entity, and I expect drug advertisements would be limited in the way cigarette ads are now.

Ruth Ann complained about how taxes would rise, under both Ed Rendell’s and a single payer plan. But here’s the thing, her company (the PG) wouldn’t need to split the cost of her health insurance with her. If she and her company were paying $250 a month each, she should expect to see a $3000 raise, plus her take home pay would be $3000 closer to her gross pay. If her taxes went up by $5000 a year it would still be worth it. The argument conservatives always seem to be making is that under single payer your taxes would go up and you still would the same health insurance bill, but that assumes you would have to pay twice for the same health care.

I’ve always thought the biblical Jesus might be a philosophical Marxist if he were around today, but I realize that might not be a popular opinion. Still, I’d like to think Jesus would see things more clearly than Ruth Ann Dailey. The current private health insurance/health care market is a clear case of market failure. A Single Payer system, while not a Panacea, would only have some problems compared to our current many problems.

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