Health Care: An Evolved Debate
Let’s, first, get one thing out of the way: much of the dialogue surrounding the Administration’s health care push – pro and con – has been stupid. In a country that honor’s free speech, lots of commentary will be worth what we’re paying, nothing. Having given that truism all the time it deserves, let’s now look at how wonderful much of the dialogue has been and how smart the American people are.
As a springboard into that discussion, I will point to Scott Rasmussen’s polling data (as cited in the NY Post article). According to Rasmussen, only one-third of the uninsured strongly support current health care reform proposals, and most uninsured believe their health care costs would increase under the proposals. A policymaker has to look at those amazing numbers and ask whether (1) the polling is flawed, (2) the uninsured don’t get it, or (3) the uninsured are trying to point the dialogue in a better direction.
I can’t speak to the accuracy of the polling. Believing that Rasmussen does a good job, I’ll accept it for purposes of this discussion.
The term “uninsured” is not interchangeable with “clueless.” In the policy arena, it’s always a good starting point, to believe that people expressing opinions are informed and sincere. Really, the only other alternative starting point is to believe that people are uninformed and insincere – in need of a ruling class to tell them what they need. Further, I would argue that the percentages reported by Rasmussen speak to a very precise understanding by the uninsured of their situation. I’ll address that situation after the next paragraph. In the next paragraph, though, I’ll speak to policymakers’ tendency to speak for the masses.
Policymakers easily fall into the trap of believing that “EVERYONE” wants something. When analyzed, the term “EVERYONE” seems to mean the 4 people the policymaker drinks coffee with. The Administration approached this issue apparently believing that everyone (who wasn’t evil or on-the-take) wanted drastic health care reform. It quickly learned that people with health care insurance tend not to believe that Government will step in and make anything better for them. Now, it looks like the uninsured don’t believe Government will make things better for them either. Are they crazy?! No, they are informed.
Rasmussen’s data pinpoints the group that stands to benefit from drastic Government action: one-third of the uninsured population. Why just one-third? Because another third of the uninsureds is covered by existing government programs, like Medicaid and CHIP; they just need to be matched up with that program. The last third are the “immortals.” They can afford insurance, but choose not to get it. They are quite correct to believe that their costs will go up. Currently, they choose to go through life with a gratis catastrophic health plan – mandated care in the emergency room.
So, the universe of “everyone” who stands to benefit from Government insurance is one-third of whatever percentage of the population is uninsured. The last census pegged the percentage of uninsured Americans at 15. So, one-third of that number would translate to 5% of the population.
Where should the dialogue go? We first need to distinguish between health care and health insurance. The 5% in question needs health care, not necessarily health insurance. As Senator Feinstein has recently suggested, part of the solution might be found in something as simple as community health centers. I would argue that no one in my community lacks availability to a basic level of health care. Anyone can walk into Nancy Neff’s Southwest Utah Community Health Center and receive excellent care from Dr. David Grygla. Likewise, people can receive excellent care through charitable institutions, such as the Doctors Volunteer Clinic and charity care provisions of hospitals and providers. We can beef up these services for a small fraction of what likely would be spend under the Administration’s current proposals.
Charges that the current dialogue is over the line don't find much support in history. Our important political dialogues have always been – and hopefully always will be – loud. Other than the Flanders family, political discussions at Thanksgiving gatherings and family reunions quickly point to the naiveté of believing that our big political discussions can be – or even should be – anything other than raucous. Much of the dialogue will be stupid, and some of it will be glorious, but in any event we are Americans and, at our best, we will demand that our lawmakers hear us. Attempts to thwart dialogue through calls for civility often are bullying tactics used by an empowered group that wants to quietly ram something through. Here, we are just starting to identify the real problem. The current dialogue is significant and, as would be expected in a functioning democratic republic, that dialogue is increasingly informed. What a country!
As a springboard into that discussion, I will point to Scott Rasmussen’s polling data (as cited in the NY Post article). According to Rasmussen, only one-third of the uninsured strongly support current health care reform proposals, and most uninsured believe their health care costs would increase under the proposals. A policymaker has to look at those amazing numbers and ask whether (1) the polling is flawed, (2) the uninsured don’t get it, or (3) the uninsured are trying to point the dialogue in a better direction.
I can’t speak to the accuracy of the polling. Believing that Rasmussen does a good job, I’ll accept it for purposes of this discussion.
The term “uninsured” is not interchangeable with “clueless.” In the policy arena, it’s always a good starting point, to believe that people expressing opinions are informed and sincere. Really, the only other alternative starting point is to believe that people are uninformed and insincere – in need of a ruling class to tell them what they need. Further, I would argue that the percentages reported by Rasmussen speak to a very precise understanding by the uninsured of their situation. I’ll address that situation after the next paragraph. In the next paragraph, though, I’ll speak to policymakers’ tendency to speak for the masses.
Policymakers easily fall into the trap of believing that “EVERYONE” wants something. When analyzed, the term “EVERYONE” seems to mean the 4 people the policymaker drinks coffee with. The Administration approached this issue apparently believing that everyone (who wasn’t evil or on-the-take) wanted drastic health care reform. It quickly learned that people with health care insurance tend not to believe that Government will step in and make anything better for them. Now, it looks like the uninsured don’t believe Government will make things better for them either. Are they crazy?! No, they are informed.
Rasmussen’s data pinpoints the group that stands to benefit from drastic Government action: one-third of the uninsured population. Why just one-third? Because another third of the uninsureds is covered by existing government programs, like Medicaid and CHIP; they just need to be matched up with that program. The last third are the “immortals.” They can afford insurance, but choose not to get it. They are quite correct to believe that their costs will go up. Currently, they choose to go through life with a gratis catastrophic health plan – mandated care in the emergency room.
So, the universe of “everyone” who stands to benefit from Government insurance is one-third of whatever percentage of the population is uninsured. The last census pegged the percentage of uninsured Americans at 15. So, one-third of that number would translate to 5% of the population.
Where should the dialogue go? We first need to distinguish between health care and health insurance. The 5% in question needs health care, not necessarily health insurance. As Senator Feinstein has recently suggested, part of the solution might be found in something as simple as community health centers. I would argue that no one in my community lacks availability to a basic level of health care. Anyone can walk into Nancy Neff’s Southwest Utah Community Health Center and receive excellent care from Dr. David Grygla. Likewise, people can receive excellent care through charitable institutions, such as the Doctors Volunteer Clinic and charity care provisions of hospitals and providers. We can beef up these services for a small fraction of what likely would be spend under the Administration’s current proposals.
Charges that the current dialogue is over the line don't find much support in history. Our important political dialogues have always been – and hopefully always will be – loud. Other than the Flanders family, political discussions at Thanksgiving gatherings and family reunions quickly point to the naiveté of believing that our big political discussions can be – or even should be – anything other than raucous. Much of the dialogue will be stupid, and some of it will be glorious, but in any event we are Americans and, at our best, we will demand that our lawmakers hear us. Attempts to thwart dialogue through calls for civility often are bullying tactics used by an empowered group that wants to quietly ram something through. Here, we are just starting to identify the real problem. The current dialogue is significant and, as would be expected in a functioning democratic republic, that dialogue is increasingly informed. What a country!
posted by steve u. at 9/21/2009
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11 Comments:
Why are you (conveniently) ignoring the fact that a public option would drive costs down for the insured? You don't think that is an important part of this debate? It does stand as an example though of what is wrong with this debate. Morons cherry-picking. I'd recommend looking at polling trends, not one poll from Rasmussen.
You and I differ on what the market effect of a public option would be. My analysis is that a public option would significantly drive up health care coverage costs (whether paid directly through premiums or taxes) -- by running private insurers out of business and pushing more of the market toward the financial inefficiencies of Government (the "crowd out" phenomenon).
If you meant to say that the debate is hindered by Mormons cherry-picking data, I'm not sure what that means. If you did mean to type "Morons," well, that's just grumpy and gratuitous.
I'm not aware of other polling data specifically concerning the uninsured, but I'd be interested to see it.
I think the Administration approached this issue with the belief that it was in the best long-term interest of the economy and the people -- and not just those people that the politicians drink coffee, Diet Coke, or Sprite, with.
There is no way this country can continue into the 21st century as a first-rate nation with our current health care system. It costs more per person than any other nation's, and the results are much worse. It's killing out ability to compete in the global economy and it's gumming up the labor market domestically.
Quite frankly, I'm moderately terrified about losing my health insurance. I have a chronic medical condition which requires daily medication. If I lost my job tomorrow, I would be bankrupt within 6 months. My talents are not being put to their best use by my current employer. I would love to go into business for myself. However, I can't quit, or change jobs, unless I have some way to pay for my medical expenses. If I go a single day without coverage, my pre-existing condition will render me completely uninsurable.
Your final paragraph is laughable. If you don't think that the tactics of those on the Right are not "over the line" or that they're just being "loud", then you're hopelessly blinded by your ideology (or pandering to your party base). How is shouting down a politician at a town hall meeting anything even close to the definition of a "dialog"?
I will gladly link to a few YouTube clips from recent Tea Party events, if you need some further convincing. Meanwhile, I would appreciate some workable solutions to these problems from everybody in charge, and a lot less political posturing all around.
the public option could still lower costs even if it runs private insurers out of the market, if it follows medicare's rates of administrative costs and eliminates the huge amount of profit in the insurance industry it would actually lower costs rather significantly.
i see anon's point with the rasmussen polling though, they don't have the best reputation right now, looking at the trends of general public polling. with that in mind a poll by the same organization focusing on one segment of the population should be taken with a grain of salt. in other words rasmussen hasn't really been doing the best of jobs lately, or, perhaps he is, and no other polling firm is (but outliers usually aren't the ones that end up being right).
but you're right steve, there isn't a lot of uninsured polls out there that are particularly recent. i'd imagine it would have to do with getting a sample size big enough to make the poll statistically meaningful, which is costly for the polling firm's.
now as to your starting point that everyone is informed. well, it's not black and white, in that it's not the case that everyone is either well informed or poorly informed in any subset of the population. in fact the uninsured would most likely follow similar patterns of informed levels as the rest of the population, some very informed, some not at all, and most at some point in between. this is problematic for your argument as you're asserting that they know how this bill will affect them, but we can't say that for certainty. they're offering their opinions, but were this a state bill wouldn't part of your vote rely on what you thought would be best for them in the long term, in addition to their immediate opinions?
Justin,
Thanks for the good commentary. I thought I was pretty clear in acknowledging that much of the rhetoric on both sides is silly. That's simply going to happen on an important issue. while I am guided by ideology, I hope I am not blinded by partisan ideology. Likewise, I hope that the Administration's backers are not blind to the fact that, amongst the silliness, many excellent points are being made in opposition to the Administration's push. Rather than pick out a few comments from public gatherings, I think the gatherings themselves and the bulk of the commentary coming from those meetings (concerning the size and scope of government) is extraordinary.
I disagree with your observations that our health care is not first rate. If people could pick the country to be in when hit by a car, shot, or diagnosed with cancer, they pick the US, if informed. If you're referring to our higher than expected infant mortality rates, look mainly to social issues, such as obesity, substance abuse, smoking, young mothers, and the mother's activities in prenatal care.
Our costs come largely from new technologies, rescue care and defensive medicine. The cost of getting the treatment you'd have received a decade ago for many conditions (e.g., 3 x-rays) has gone down; the increased cost comes from the fact that you'd now get much more treatment (CT scans, MRIs, and new innovative surgeries to fix the problem, etc.). Our outcomes are excellent, factoring in that we actually treat and report issues that other countries would write off as nature.
We can do a better job with things like cost containment, public health promotion, defensive medicine costs, tough decisions on rescue care -- but we shouldn't pretend that those things are part of the current proposals. Again, the proposals are focused on insurance coverage, not health care delivery. If you disagree, I'd be interested to know how you conclude that anything the Administration is proposing would lower costs. Without lowering costs, the plans simply move costs from the private sector to the public sector -- thus, the accurate arguments of socialization.
My proposed solution is to focus on the undertreated, through community health clinics. (I ran legislation to do that, 2 years ago). To reduce health care costs, I'd add that we need to get after defensive medicine. To reduce insurance costs, allow greater competition among insurers, by reducing mandates and facilitating interstate competition.
Craig41,
Brilliant points, excellently stated. I didn't know that Rasmussen is developing a reputation. My unscientific reviews have traditionally found it to be okay. Dealing with constituents every day, I would not argue that every constituent is perfectly informed every time (like they would not argue that I am perfectly informed every time). But I would argue that the mass of voters on a high-profile issue are informed (a "smart mob" according to Rheingold).
Your last few sentences deserve their own post. Yes, sometimes I will vote against the bulk of the input I am receiving, if I conclude that I'm hearing from a ramped up segment or that I'm hearing "quick" input. But, I think I'm getting much better at realizing that voters will put their elected officials in the right place, if elected officials will invite, help educate, listen, and learn.
(Insert voucher jab below).
all i have to say is this i am a self employed type 1 diabetic that can't get insured unless i close my business and work for some or go on the government programs which i refuse to as a proud american i know that we have been bankrupt since our last horrible president bill Clinton in fact one reason why our health care system needs help is because of the Medicaid and Medicare programs choosing what to pay out to the doctors and pharmacological companies and so for the private sector to make a profit to they can stay in business they have to raise there rates to everyone else willing to pay the price so one of my solutions is get rid of these two bogus government programs (Medicaid, Medicare) not to mention we should also tear down state boundaries so anyone in any state can buy any health insurance in any state which encourages competition hint: supply and demand next we also need tort reform which would drive mal-practice insurance for doctors down in cost which encourages more doctors to go into practice hint: supply and demand
the key here if no one has gotten the point is competition drives costs down and getting the government out of our lives
Tort reform is a ruse. 38 states already employ the "reform" with no change in cost, and malpractice lawsuits amount to a very small percentage of growing health care costs.
I'm also with Craig41 on this. The "informed/misinformed" ratio in the health care debate seems to be less black and white, and more slanted, with the opposition to the proposed reform heavily waiting the "misinformed" side of the scale. I attended many townhalls, and in all honesty (and a little partisan gloating) I did not hear one single statement of opposition that wasn't based on a large amount of misinformation, fallacious reasoning, and outright misunderstanding of what is being proposed, what has or hasn't happened in other countries who've addressed growing health care costs, and what the House bill actually does or does not say (cough, cough, Mssrs. Buttars and Valentine!)
I would be more suspicious of something like HR3200 if anyone were providing a reasonable, cogent, and educated example of why we shouldn't adopt such a strategy.
"Driving insurance companies out of business" is a ridiculous notion in general, Steve, and one perpetuated without much weight other than ideological parroting. The postal system has hardly influenced UPS and Fedex. Charter schools are actually invigorated having to compete with public schools. Etc. And this mindless memo also ignores several facts of other countries that employ programs very similar to what is being proposed, yet have a very vibrant private market functioning within the same system.
If insurance companies are so fragile, perhaps we should be doing away with them altogether anyway, as it seems it's only a matter of time before something takes the poor porcelain things out anyway (like a strong wind?).
Interesting post, Senator, particularly the part about charity care. I'm familiar with those St. George clinics, and I definitely agree that local clinics like these can do much to help those who can't afford insurance or, more importantly, those who can't afford health care, as you point out.
You may be aware that the Sutherland Institute has published a piece that offers the Legislature some policy recommendations it can use to encourage more authentic charity care in Utah. You can see it here:
http://sutherlandinstitute.org/uploads/CharityCarefinal.pdf
At this point, charity care might not be common enough or organized well enough to help every Utahn in need, but should the Legislature choose to endorse and encourage authentic charity care along with the health care reform task force's continued efforts to lower costs, then I think we can help everyone in need, and do it with much less government involvement than most plans advocate.
The people are the solution, not government. Charity never faileth.
Charity health care alone does not have the financing or the capability to provide medical care for the millions of uninsured. We need to train more doctors and nurses in our universities or all of us will be standing in long lines waiting for medical treatment.
I suggest that the federal or state government offer medical scholarships for physicians and nurses and then provide funding for universities to train these additional medical personnel. In return for the scholarships, the doctors and nurses would provide free or sliding fee medical care for the un- and underinsured for a 3-4 years after graduating. They would receive a stipend for their services.
In addition, we cannot adequately provide health care for all residents without addressing and solving the illegal alien problem. Those who live in Southern California and some cities in Texas report that illegals are flooding the hospitals for routine medical care. Some hospitals in San Diego have been forced to close because they have gone bankrupt, largely because of the illegals who have used ER rooms for medical care. Illegals must either be deported, become legal citizens, or receive a green card. We can no longer afford as a nation to care for the millions of illegal immigrants who are overwhelming our health care system.
I appreciate the commentary on health care (and other issues), ... but you really need to do something about the comment spam.
I don't use the blogger service, but it seems that other open comment blogs don't have this problem--what's going on?
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