Wednesday, June 15, 2011

There are irony and lies, if you look for them ...

There's irony in the world if you look for it. I happened to "like" something on Facebook called The Urban Commuter. They mentioned that tomorrow is national "Dump the Pump Day", an attempt to make a statement about how we waste gas in commuting by car (save us some money and save the country some oil). Meanwhile, even as we are trying to wean ourselves from our cars (a bit), Maureen Dowd has an opinion column on how Saudi women are trying to achieve some small increase in their rights. Among other things, she mentioned that Saudi women are being encouraged to participate in a national "drive in" on Friday. We are stepping out of our cars as Saudi would like to step in. Well, I guess they have enough oil to run the things.

I have to say I think that there are counter arguments to make when liberals (unfavorably) compare American health care to that of other industrial nations (Europe/Japan/Canada/Australia/New Zealand and probably some others). Maybe a case can be made that other countries government run health care con only exist if there is a US for profit health care system to handle their most expensive cases. Maybe. But you can't reasonably just ignore the existence of the health care systems of these other countries, and the fact their public health stats and costs are better than ours.

Unless you are a Republican named Paul Ryan. (To be fair, I suspect all Republicans and even at least a few Democrats would cheerfully ignore other countries health care successes). (I came by this thing via Paul Krugman's NYTimes blog)

I still think about the conservative commenter on 2PJ's who complained that liberals/progressives are not serious, and conservatives can not have a discussion with them. Apparently it works the other way as well.


Bitter Clinger said...

The two major sides of the Health Care arguments going on right now (leaving out the Libertarians and the Social Conflict people) are between the Functional Structural and the Symbolic Interaction viewpoints. The FS’s lead by Paul Ryan say that Medicare has X dollars and Y recipients and that we should divide X by Y and send everyone a check. “On Average” the population will be better off (I can show this statistically, read Freakonomics for clearer explanation) while the SI’s lead by Paul Krugman, want a panel of VIP’s (Very Important People) to make the rationing decisions on who lives, who dies, what treatments are supported and what is not. John Nance, If Hospitals Could Fly, says that if your system requires the competence, the correctness, and the un-corruptibility of the participants (VIP’s), it is doomed to failure. I believe we have 6,000 years of history to collaborate that observation. The point is there is no middle ground. Neither side will attack the root of the problem which is the predatory monopolies of the AMA, The FDA, and the pharmaceutical companies. Canada, as Krugman points out, only spends about half as much as we do per person and gets equivalent health care. So who is going to take the “haircut”? Are Doctor’s going to make less (Doc Fix), are the pharmaceuticals going to take less, how about medical staff, nurses, and clinics? Or maybe Krugman is lying and Canadians only get half the healthcare and drugs we do. I would like to have an adult conversation, do you?

EdHeath said...

Part one of two -
OK BC, as you might suspect, I would be interested in an adult conversation. But first a couple of things: You have no reaction to Paul Ryan’s (non)response to questions about the supposed success of other countries health insurance systems? Ryan didn’t didn't even go your route and trash Canada. Other people who might read this blog would surely notice that you did not comment on that.

Also I have no ideas about your labels Functional Structural or
Symbolic Interaction. I don't know who is using these labels or what theoretical framework they might fit into, so I can't play along with that part. I reject whatever pre-conceived assumptions these labels might carry., at least as long as you provide no background or source for there labels.

I will say that economists believe that in at least some social welfare programs, giving someone cash directly or even a voucher is superior (in terms of maximizing the benefit to them) than providing a physical thing, such as high rise housing or some particular type of food. You can certainly find references to this in various microeconomics texts. However, I believe health insurance is a different service in economic terms. Given the amount of research you apparently have done, I assume you have come across the notions of “groups” in insurance, health and otherwise. Participating in a group setup in health insurance means that there will be different kinds of people being insured; basically those who get sick more often and those who get sick less often. Everybody in the group pays the insurance company, but some will use the insurance more than others. There is always a fraction of any group that will get sick, but the larger the group, the better able the group is to absorb the costs of the sick. Of course Paul Ryan’s plan eliminates the benefits of being in a group for senior citizens. The health insurance companies will charge the elderly a higher rate as individual subscribers than Medicare would need for the whole group of American elderly. This is not to mention overhead costs, such as claims processing and advertising, which are higher for private insurance companies than for Medicare. .

There is a larger issue about why Medicare is going broke. Yes, the number of Medicare subscribers is growing relative to the number of working age people. Decades ago, there was some large number of workers for every Medicare subscriber, now because people are living longer as well as the demographic phenomenon known as he baby boom, that number is changing. But there is also the cost of health care itself, the rates charged by doctors and hospitals. That cost has been rising faster than the rate of inflation for some time now. It is partly driven by how much Medicare is willing to pay, but in my opinion really Medicare is being dragged upward by the amounts that private insurers were willing to pay. Now both private insurers and Medicare are attempting cost savings measures and caps on charges. Medicare actually has some bargaining power because of its sheer size, but the cumulative effect of the private insurers is greater.

As for the panel of people making decisions about what and how much should be paid, do not kid yourself (or us) that private health insurance does not have this same sort of panel. I worked for a time at Blue Cross (at a low level) and I know that private health insurance has the same sort of panel, the only difference being that a Medicare panel could be questioned by the public and asked to justify their decisions. A private health insurance panel is answerable at best to stockholders, or perhaps only the firm’s CEO .

EdHeath said...

Part two of two -
The issue of income for doctors is a bit more complicated. Doctors do tend to be wealthy (not the super rich, but well off), so for one thing they have political power disproportionate to the size of their group. And it is always difficult to tell someone that their income can (at least) not grow as fast as in the past, or even that they need to accept a pay cut. I notice, though, that conservatives have no trouble telling teachers or the poor that they have to live on less. And by the way, doesn’t the Ryan plan reduce doctor’s compensation as well?

The only people who seem to suggest that Canadians, Europeans, the Japanese, Australians, New Zealanders or any other industrial nation have inferior health care to that in the US are conservatives. All the reports I see from Canada itself praise Canadian health care. They seem to realize they get a good deal. Their doctors are apparently happy that they can practice medicine rather than deal with insurance companies either negotiating for payment or as captives to one insurance companies polices for procedures and reimbursement. I might suggest TR Reid’s “Healing of America” as a book for you to look at to get a perspective on other countries health systems.