Question for Romney Supporters
I just don't understand the enthusiastic support for Mitt Romney and his description as an heir to the Reagan legacy. In particular, he claims to single-handedly have implemented HillaryCare in Massachusetts, the program that was arguably responsible for sweeping the Republicans into Congress in 1994. My sense is that Hillary in the intervening years has moved on to an even more socialist plan, but everything I see in the Romney plan looks very much like Hillary's original proposal.
The plan is command and control at every turn -- for example, I am a huge believer in high deductible health insurance. My family has saved a ton with it, and it shifts health insurance to be more like, you know, insurance -- meaning it covers catstrophic, bankrupting problems but not day to day expenses. Well, this sort of very reasonable plan, which has the added benefit of bringing some price competition to medicine because people like me now care about prices, was made illegal in Massachusetts by Romney and Company. Romney strikes me as just another 1970's-style big government Nixonian Republican, like nearly every other Republican in the race this time around.
m:
My understanding is that the plan Romney proposed was far better than the bastardized plan that was implemented by the state legislators. Read this article, especially under the heading "Formulating a Plan".
January 11, 2008, 11:51 amDavid B:
High-deductible insurance is great unless you're in a family where someone has a chronic illness. My wife needs really expensive, regular care, and it hits us hard.
January 11, 2008, 1:45 pmReformed Republican:
David B,
Then what you are looking for is not insurance. You are looking for someone else to pay for your wife's medical care. Insurance is supposed to be for the unforeseen. A chronic condition is not unforeseen. That is like wanting to buy car insurance to cover an accident that already happened.
Of course, our current system has led people to completely misunderstand what insurance actually is.
January 11, 2008, 2:09 pmFay:
Reformed Republican: No, actually, they're looking for insurance that pays for what it's supposed to pay for. Chronic conditions are indeed unforeseen until they're diagnosed. I bet that unless she has employer-sponsored coverage, and maybe even then, most insurance companies deem that woman "uninsurable." So that man's wife is just supposed to die in the street, because your version of insurance isn't supposed to cover her? Or they're just supposed to "work harder" to make more money because she has a chronic condition? Yeah. That's really "reformed" of you.
January 11, 2008, 2:29 pmJoe Martin:
@Fay I agree that chronic conditions are unforeseen until they're diagnosed. But what about after they're diagnosed? They're no longer unforeseen. Her current coverage (what she had before she was diagnosed) probably has a set limit of how much they'll pay out over the lifetime of the coverage. If the family tries to get a new coverage plan, the condition is no longer unforeseen. It's now a known quantity and what they're looking for isn't insurance, but a subsidy.
That's fine. I'd want a subsidy too if something was going to cost me money for the rest of my life. The real question is, who pays for that subsidy? You're pretty sarcastic about the idea of "working harder" because of the chronic condition. And yet, nothing in life is free. Somebody does have to work harder. If her family is part of an insurance pool, everybody in the pool pays more to subsidize her care. If her country has national health care, everybody in the country pays more to subsidize her care. Then everybody's "working harder".
Other than the fact that it's no fun, I haven't really seen anybody explain why they shouldn't work harder, but I should.
January 11, 2008, 3:21 pmFay:
Well Joe, that is exactly my question. What if, like most people who can't afford their own health care, she already DOES work hard? What kind of country are we? Are we going to subsidize people who can't afford their health care, or are we going to let them die? The "free market" would undoubtedly let her die, or go bankrupt, or both, as our current "system" now does to thousands of people every year. I have no problem with everybody "working harder" so that no one goes bankrupt paying medical bills. I know that's not very libertarian of me, and in fact I am kind of a "bleeding heart libertarian," I suppose. But good lord. Pretending that a sick woman deserves to NOT get care because insurance isn't cutting it for her... that's a worse alternative.
For me it's about priorities, which I'd bet even the biggest free-marketers could agree with me about. How about if we spend less taxpayer money launching pre-emptive wars, and more money subsidizing people for whom the health care market doesn't work? And I'm not even talking about the technically poor. Many middle-class and even upper-middle-class self-employed people are basically completely screwed if, say, they get diabetes, or a head injury, or crohn's disease. I do not think that's okay.
I do agree with the general principle of letting people choose their policies... for example, that hypothetical current coverage of hers, if it's employer-sponsored, is probably one about which she didn't have much choice, including the cap it sets on benefits. I do wonder whether if we all bought health insurance like we do car insurance, if the prices would come down and be more manageable. But given the current behavior of the insurance industry across the board, I still think it's highly unlikely that people with chronic conditions would have much access to affordable care. And I don't think it's okay to just let them suffer. It's a tough question... but the whole "screw 'em if they don't have the money, they're just not working hard enough" attitude is what really bothers me.
January 11, 2008, 4:09 pmJoe Martin:
Fay, the "free market" in healthcare is completely non-existent. Don't kid yourself. The healthcare system is probably the most regulated and restricted "market" in the entire United States. For instance, the government restricts supply by strictly limiting which pieces of paper allow what kind of doctor to do what procedures.
You say that "the "free market" would undoubtedly let her die, or go bankrupt, or both, as our current "system" now does to thousands of people every year". I simply don't believe that's true. An unregulated market would definitely have lower prices than we currently have. Part of the reason healthcare is so expensive, is that no one knows what it really costs. Have you ever seen a hospital or a clinic competing based on price? Have you ever even seen up-front prices, period? I certainly never have. How is an industry supposed to get more affordable if no one even knows what they're paying?
Furthermore, I think you're ignoring the role of private charity. I'm willing to help out people that I personally know that need help. I'm not willing to subsidize perfect strangers living halfway across the country. I have no idea what they're spending the rest of their income on or how badly they need help. I think most people feel the same way.
I also think you're a bit unfair to the insurance industry. You've given them two competing mandates: make healthcare affordable and pay for everything that needs paying for. How, pray tell, should they meet both of those criteria? The only way for them to make healthcare affordable is to prevent people from getting care that they don't need and to put reasonable caps on care that they do need. The only way to pay for everything is to let costs balloon. Pick one.
Overall healthcare spending in the U.S. has been steadily rising over the last several decades. Having the entire country subsidize the entire country won't do anything to reign in costs. It will only ensure that spending continues to rise as people spend each others' money far more freely than they spend their own. The only way to lower prices is to increase supply and make people responsible for their own spending. Only then will they demand -- and get -- lower prices. Right now, people aren't responsible for their own spending. In the 1960's, at least 50 cents of every healthcare dollar came directly out of somebody's pocket. Today, only 15 cents of every healthcare dollar comes directly from somebody's direct. (cite) 85% of healthcare costs are hidden. That's not a formula for cheap healthcare by any means.
Unchain the market and David B's wife will be able to get drastically cheaper care. An unhobbled market really would work.
January 11, 2008, 9:55 pmmacquechoux:
Just a couple of comments here:
I, too have a high deductible health insurance policy coupled with Health Saving Account. (Or is it a Medical Savings Account?) While visiting a lady friend of mine in another city several years ago she developed the flu. And as it was the weekend her regular doctor was not available. She asked me to check on a couple of nearby walk in clinics and I did so. One was $85 and the other was $115 for a visit. She chose the $115 clinic. I asked why. The $115 one was a little bit closer and “nicer†meaning newer and besides her insurances paid 100% for walk in clinics and it didn’t matter what it cost. Talk about a lesson in economics there.
It is very hard to make a comment about the fellow with a wife that has a chronic illness not having the particulars. My observation is that in the US the only people that die in the street are street people, commonly referred to as “homeless.†The vast majority of these people are schizophrenic, alcoholics, drug addicts or some combination thereof. I don’t think this applies to him or his wife. Dying in the street is a straw man argument.
“My wife needs really expensive, regular care, and it hits us hard.†I don’t know what “hard†is. However there is Medicaid for “really hard.†In my state, Louisiana, there is also a state charity hospital system where free health care is available for any and all conditions. I see no point in arguing about this fellow’s plight without knowing the conditions and defining our terms.
January 12, 2008, 6:49 amFay:
Joe, I see all your points. Thanks for stating them so politely. :) With that I'll say, I agree with macquechoux that debating this hypothtecial person's plight is kind of silly.
In general, I just don't trust the free market with my health, and feel that some regulation is necessary to mitigate the influence of the bottom line. Also, my general problem with private charity is that it can, and does, discriminate. I don't think that's okay either.
January 12, 2008, 4:17 pmMark:
Everyone loves the free markets, and so do I. But the "free markets" reaction to a chronic illness makes it impossible for these people to find health insurance. The same is true for people that have had extensive medical problems in the past.
But this is typical of the libertarians. Their views on every subject ignores realities like this. Oh, the chronic illness is "forseen", whatever that means. Apparently these people believe that a person with such conditions or medical history should just get on a high deductible plan like they have. But the fact is that such plans are not economical for such people because they have "forseen" medical costs.
A $5,000 deductible plan is great for people without any health problems. THe probablility of them having more than $1,000 in medical expenses are very low. Once you add up the actual medical costs and the low premiims of such a plan you get significant savings.
But what if you have chronic asthma and have about $300-500 in medications you take a month?
First, there is not a private health insurance company that will ever accept you. Your medical costs will always be more than any reasonable premium you are going to pay.
Second, the libertarian claim of "subsidy" is not a subsidy. It is reasonable health insurance pooling, another aspect of INSURANCE that you are completely ignoring. IN fact, this is the MAIN reason for insurance. I pay the premuims on my insurance so that if I run into unexpected costs the insurance "pays for it". So, any catastrophic usage of health insurance I encounter means that I am receiving a "subsidy" in these freaks minds.
Third, the only way that a private market in insurance can be created is if the government or some other non-profit steps in to guarantee insurance for people who will not be covered by the underwriting process of for profit companies.
January 13, 2008, 9:31 amAllen:
The problem is that one has to remember that a truly free market would change the paradigm completely. I have a condition that isn't chronic but I know about. Every now and then the bacteria growing on my skin gets out of control. It happens to some people for some reason. We all have bacteria growing on our skin at all times. Just for some reason I'm prone to have problems with it getting out of control. So when it does it means going into the doctor, having the doctor confirm what I already know, writing out a prescription or three, then having a pharmacist fill that during business hours and me waiting around to pick it up. Take that out of the equation and I could simply go buy those antibiotics from whomever I choose. Taking the doctor's visit, which seems to half the time be a visit to urgent care (and thank god for urgent care instead of the emergency room) out of the equation. There goes a three hundred bucks to know what I already know at this time. It would also mean that instead of me sitting at work at 10am and having to take 1/2 day off of work to run in to the doctor because I realize it starting in again, I can take 30 minutes to run over to Target and get the drugs. And while I wouldn't buy the drugs in a back alley I don't really need a pharmacist for this sort of thing. I just need the usual run of oral antibiotics along with a topical cream. And on that end there would likely be savings taking the FDA, the pharmacist and such out of the equation. It doesn't sound like a big deal but we're looking at something that's pretty routine cutting the cost by half or more.
As for chronic conditions, the problem is the ongoing cost. The current system doesn't really address that does it? It helps to make things look as though it's doing something. But remember that money doesn't grow on trees. The money is coming from someplace. It's coming from those paying in for insurance who don't tend to have things going wrong. They're paying more. It also comes from the employers. Instead of paying more in wages, they have been paying that money into health insurance. It's a catch-22 situation. The less they have for wages, the more we're dependent on having insurance cover the health equivalent of an oil change or putting new belts on a car to get by. Think of how much you could cover if you had another $500-$2000 / month to cover health expenses. Changing the paradigm won't create a utopia. But as a whole it lends itself to actually bringing down the cost of health care rather than having bureaucrats putting a cap on spending. A cap on spending isn't reducing costs; it just limits spending. And the public as a whole putting a cap on spending isn't any different than issues would have if they were struggling with finding insurance in the first place.
January 13, 2008, 12:19 pmAllen:
macquechoux ---> What problems have you had with the relatively free market of food? Do you not trust it also? Not to be rude but reading the comments about even charity discriminating makes me suspect that anything that doesn't give you a promise of all-you-can-eat prime rib isn't good enough for you. Surely you realize the government completely running health care isn't going to get you that either. For example, the VA for decades' has been plagued with problems. Heck, just look at Walter Reed. I know it doesn't solve all the issues that arise from being poor by freeing things up in the health care market. However going the other way doesn't do it either. It simply ensures that everyone has to put up with the same crap rather than 5-15% of the population.
January 13, 2008, 12:23 pmScott Wiggins:
I can't speak to the particulars of Romney's healthcare plan. However, in response to your lack of understanding of Romney supporters I would say that by focusing on healthcare you are cherry-picking a pet issue. The next President will deal with an array of issues from the GWOT to Supreme Court appointments. If we all look for a candidate to support our pet issues we will remain a hopelessly fragmented party. For many, Romney represents a smart articulate world class leader. He has a history of success in both the private and public sector. He is quite frankly an obvious choice.
January 13, 2008, 2:07 pmJoe Martin:
Mark, I think we may be talking past each other. I'll respond to your three points in an effort to clarify things.
I think your first statement is incomplete. It would be better to say: "there is not a private health insurance company that will ever accept you for chronic asthma coverage". And that's true. It wouldn't make any sense. To be fair to the other members of the pool, they would need to charge you at least as much as your care costs. But they might be willing to cover you for other risks unrelated to your asthma.
Second, I completely agree with the pooling aspect of insurance. You're correct, it is the main reason for insurance. Without it, there's no difference between paying a monthly premium and making monthly savings deposits. Because of pooling, I can draw on more than my own funds if the unexpected occurs.
But what do we mean by "unexpected costs"? I mean a one-time event: injuries resulting from an accident, a sudden illness, or an attack of some kind (heart attack, stroke, etc). An insurance pool can protect against these events. They're limited in scope and probably will only effect a small portion of the pool at any one time. The more that the pool tries to cover -- and the longer it pays out for each individual -- the more it will need to charge. A pool that covers truly unlikely events will be very inexpensive. A pool that covers likely events will be very expensive.
This is why I said that David B was asking for a subsidy. He was asking for a regular, monthly payment that (from what he implies) will be needed for the duration of his wife's life. To cover that kind of expensive, he and his wife would need to be members of a fairly expensive pool. In addition, the other members of the pool would be paying in money that would be going right back out to support he and his wife. That is the very definition of a subsidy.
I never claimed (and will never claim) that having insurance pay for catastrophic events is a subsidy. I only claimed that having insurance pay for ongoing, known costs is a subsidy. That is, costs that are known about at the time that insurance is purchased.
I don't understand your third point at all. A private market can be created in the absence of government and non-profit guarantees. It is true that that market may not cover 100% of the conditions of 100% of the people. But that market will exist and will provide coverage for many people.
January 13, 2008, 6:28 pmAndy:
Scott, Joe & Allen; spot on!
January 13, 2008, 6:52 pmMark:
"But that market will exist and will provide coverage for many people."
And that is great if you are one of the many people. THe problem is that you will have a significantly different opinion if you were one with a chronic illness. These people will always be denied by insurance companies. ALWAYS.
In a free market all actors in the market must have the same or similar market power. Yet, in the health insurance market you have a situation were certain segments of the population will not be given the product at no fault to themselves.
The situation were there is inherent unfairness in such an important market must be addressed. The fact that libertarians address this as "who cares" shows that they are not thinking seriously about the situation.
But, the health care system can be reformed fairly easily.
I believe that everyone should get individual policies with reasonable deductibles from an unfettered market.
Individuals with chronic illnesses, such as asthma and diabetes should receive heavily subsidized reinsurance from the government. The reinsurance will cover costs associated with these chronic illnesses and remove this risk from the private insurance carrier. Then these individuals will be able to get the same health care insurance that you do.
People who cannot be covered by individual insurance programs must have an insurer of last resort. In my home state of Minnesota this program is known as MCHA. Such programs should be subsidized with taxes on the health insurance premiums of other people. This tax essentially is community pooling.
The "uninsured" would be continued to be covered by the governemnt, BUT, as with everything there should be appropriate deductibles based upon their income level. This will prevent the overusage and radical increase in demand. But, the point is, everyone would be covered. This coverage would allow us to efficiently deliver health care coverage to the poor and uninsured. There would be rules and rationing of this care that would be extensive, and waiting periods for the government "insurance" would be substantial and on par with the universal coverage state.
That is the cost of going on the government dole. THey will not get priority. THey will not get the best of treatment and equipment. They will not get the best doctors. And their access to specialist will be limited.
Maybe that would be incentive to become productive?
January 13, 2008, 8:26 pmReformed Republican:
"Yet, in the health insurance market you have a situation were certain segments of the population will not be given the product at no fault to themselves."
Without government regulation forcing insurance to cover specific conditions, which largely results from employee provided, group plans, people with chronic conditions would be able to get health insurance. It just would not cover their known, preexisting, chronic conditions. Again--looking for coverage of an existing condition is not looking for insurance. It is looking to get other people to pay for your condition. Period.
Putting them on the government dole is not better. It is still taking money from other people. Just be explicit about what you want. Be honest and say that you do not think people with chronic health problems should have to pay for them. Other people should.
January 14, 2008, 12:14 pm