Friday, August 3, 2007

No Kidding About Coverage

When logic cannot work, try mouthing inane phrases to discredit a sound measure. That's the tactic of choice for our Republican lawmakers and our President once again. The issue at hand is extending and expanding the Children's Health Insurance Program so that it covers children of lower middle class families in addition to poorer children.

The House has passed this Bill 225-204 over vigorous objections by Republicans and threat of veto by President Bush. Their objection is that this would expand "socialized medicine, and Washington-run healthcare." Well, so what? If this form of healthcare works much better than the alternative (and there's every indication that it does) then why should those terms be any grounds for opposition? Two thirds of Americans favor universal coverage, leave alone this more popular issue of covering children.

Interestingly, while 5 Republicans voted for this bill, 10 Democrats opposed it. Those 10 probably caved in to lobbyists or constituent special interests. I'm guessing their opposition arises because of the way this program is financed: by increases in tobacco taxes and cuts in subsidies to the Medicare drug prescription plan.

Paul Krugman wrote a good piece about this today in the New York Times, though it is unfortunately available only to subscribers. Here's the part I particularly liked:

"...The bill is so good that it has Republicans spluttering. “The bill uses children as pawns,” declared Representative Pete Sessions of Texas. Yes, the Democrats are exploiting children — by providing them with health care.

The horror, the horror!

What’s especially encouraging is the way House Democrats were willing to take on the insurance companies. The bill pays for children’s health care in part by cutting subsidies to Medicare Advantage, a privatization scheme that yields big profits for insurers, but that the budget office estimates would cost taxpayers $54 billion in excess payments over the next five years...."

Of course Bush may well veto this, but with all their spin that will probably cost Republicans big in the 2008 elections.

6 comments:

kenrod said...

Sandip,
You are being disingenuous and intellectually dishonest by claiming the Children Health Insurance Program is about children. It's about giving another handout to families that make upto $60,000, and in some cases, $80,000 a year! When are these entitlement programs going to stop?

Budget experts estimate that entitlements already spend 75% of all the outlays. That means there is nothing else to cut. We could pull out of Iraq, we could stop going to the moon, we could stop foreign aid.... None of it matters because most of the money is already spent.

Besides, this program is a surruptitious way for the liberals to take over the health programs of America. First, they take over the seniors through Medicare. Now, in the name of "children" they implement another giveaway.

And while people say they want universal coverage I suspect they want universal access. So we can reform underwriting guidelines for insurance companies. Americans do not, as a rule, want a one-size-fits-all. Medicare is a such a plan. There is one deductible for PPO plans, and the Advantage plans have very little variation.

And what so good about government run universal plans anyway. The Wall Street Journal on August 4, '07 in an article "Sicko Europe" wonders why Europe, with government care, has higher cancer rates. It's because the govt will only pay for the cheapest drug in a category which leads to confusion.

The New York Times on July 28'07 reports Medicare is the problem in this system. That's because Medicare will not vigorously challenge claims by doctors the way private insurance companies will. My aunt, Margaret, is a typical example. She went to the doctor for one visit and got an EOB for eight visits. Since she's old and didn't have to pay anything out of her pocket, she didn't bother. And Medicare paid all those extra bills.

And while Republicans may lose the next election, it won't be because of healthcare. Notice none of the Democrats have mentioned the words, "socialized medicine." They know, with most of the budget already gone in entitlement programs, another one will be disasterous.

Sandip Madan said...

Kenrod, thanks for your insights about my intentions. :-) I've always maintained that universal coverage is not only desirable but socially and economically more efficient as well. And this extended SCHIP is the right step in this direction. So I support basic healthcare coverage as an entitlement and don't think of this as an unnecessary handout.

It is through this system that Europeans manage to achieve more than us while spending half as much. While I shouldn't set too much store by it, US public opinion currently mirrors my thinking. See:
http://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtml

The reason Democrats don't say "socialized medicine" is because industry interests and Republicans have managed to attach negative connotations to it and stigmatize the term. Besides, why would it be necessary to call it this? How often to you hear terms like "socialized police" or "socialized army" though they follow the same concept?

By the way, the current healthcare system with its high costs and problems actually strengthens our value proposition of medical tourism. If the system is fixed here, fewer Americans will want to flee abroad. So I don't know why I'm disagreeing with you and letting my conscience get the better of me. :-)

kenrod said...

I don't support universal healthcare and my conscience is very clear. In fact, my sister just came back from Russia where things are socialized and what do you find? Poverty in a land of plenty.

And I'm not talking about a few bums hanging out on the street here or there. But the masses are starving and the only hope is to privatize industries.

But what really bothers me about universal heatlhcare is everything will have to be reduced to the Lowest Common Denominator. I don't eat at Morton steakhouse where a meal could easily run $100 a person. Nor do I eat at Mcdonalds, but I do want to eat where I want.

The problem with universal healthcare is that it will be reduced to the Lowest Common Denominator. While I don't despise anyone who eats at Mcdonalds I don't want to be forced to eat at one. And while I know the elite eat at Mortons, I don't envy them.

And as I explained before, we don't have a problem with a socialized army because only the govt should run an army or police because you don't want to see me or my next door neighbor running one. Government should only do for citizens what citizens can't do for themselves.

Universal healthcare may work in countries where the population is small and relatively well off. In Sweden, Hong Kong it's okay. Even in Sweden my friends report that on a cold snowy night, suddenly the case of stomach aches and backaches shoot up. The homeless suddenly want to use the emergency room as their temporary hotel. And that drives the costs up. While Sweden can handle it because homeless numbers are miniscule, can you imagine the Bronx?

No, I find SCHIP a wrong direction for society. A sneaky way for liberals to take over the best healthcare system in the world and reduce it to the LCD. Fiscal conservatives have tried to vote in Republicans to balance the budget. That apparently has failed. Now we must fight every entitlement. Every handout. That's the only way to bring personal responsibility back to society.

Sandip Madan said...

We should compare European countries like Germany with the US, where per capita incomes are equivalent, not Russia. I don't know much about Russian healthcare, but will readily acknowledge that universal coverage can be messed up if done badly. Just like the state of FEMA here during Katrina.

With two-tier health systems of Europe you have no problems with eating at Mortons Steakhouse if you want, but there's a very decent soup kitchen available for everyone as an option. That's one shortcoming in the Canadian single tier system though, where your Mortons example is very valid.

By the way universal coverage does not preclude a big role by private insurers. They may be able to administer it better and more efficiently than a government agency under the right conditions. I suspect Hillary is leaning in that direction.

kenrod said...

But while liberals want to expand SCHIP they want to cut back on Medicare Advantage plans. Why? Not suprisingly, it annoys them when private companies make money. It's okay if govt misallocates resources. But it's the end of the world if private companies try to make a decent profit.

Liberals never understand the power of markets. There is no such thing as excess profits when adequate and true competition is present.

If a company is making "excess" profits, say 40%. If there is competition in the marketplace and another thinks they can do it for 30%, they will enter. And the price will keep going down until they reach their Cost of Funds.

Today, we have over a dozen companies that offer Medicare Advantage. Each will compete to bring more benefits to seniors until the point they can no longer make a decent profit. And the same principle applies to the Senior Medicare drug program.

Govt should only function to preserve anti-trust laws to make sure there is enough competition in the marketplace. Not take over the marketplace like they have in SCHIP.

What they have done in this case is give a benefit to people who didn't really need it. The poor children were always covered by Medicaid. Now people like my brother who make $75,ooo, take their children off his work's Kaiser policy and get a free handout from the govt.


And how does the govt pay for this? Extra taxes of course. While we all pay taxes, when it gets excessive, the economy goes underground.

And the favorite punching bag is the tobacco companies from which the govt hopes to raise taxes. Well, there is only so much you can raise before smuggling or illicit behavior takes over. Now the govt has just encouraged mafia behavior which is evidenced by the massive amount of the large busts of illegal cigarettes.

And I prefer legal companies like Wellpoint or Healthnet to make a profit instead of the mafia.

Sandip Madan said...

Kenrod, there are two additional aspects that may be factored into your free market exposition, which is good.

Firstly, a really free market will eliminate middlemen that don't add enough value. But Medicare Part D (the drug program) is structured so this cannot happen, so in theory this CAN lead to waste and suboptimal use of resources.

Secondly, in a situation where there are increasing economies of scale (including the purchasing clout of a single large buyer), you may be left with just one entity. In that case it MAY be better to allow that one entity to be the government aiming at public welfare instead of either of the two alternatives, a private profit maximizing monopoly, or forced fragmentation of the market into smaller suboptimal entities.

So there's no clear conceptual answer, and it boils down to the benefits versus the middleman costs of drug distribution through insurers.

I agree with you that milking this tobacco cow any further is likely to have negative consequences. But I may be fine with funding SCHIP through additional income or property taxes. It all again depends on the benefits versus the costs...