Posted by: mutantpoodle | August 1, 2009

Health Care Follies

I have ranted about Health Care reform in this space before, which was very satisfying but perhaps not terribly illuminating. Over the past weeks, as opponents of reform have – how do I put this – LIED about what President Obama and most Democrats in Congress are trying to do, there’s been a cottage industry of people working nearly full-time at debunking. For example:

And there are many more – plus an equivalent number on the other side of the argument. Note: when Fox News (above) is debunking anti-reform arguments…

A lot of the propaganda against health care reform is demonstrably – well, false may be too mild a word when some opponents are saying the government will KILL YOUR GRANDMOTHER, but let’s stick with that.

This lengthy preamble brings us to a conversation I’ve been having wither twitter friend @annalisa2, prompted by a link she provided to a British woman railing against their National Health Service. I forwarded her the American Prospect link above, and she took it to her blog to break chains of the 140 character limit, and responded.

Argument by anecdote is fraught with peril – you give me a Canadian / British horror story, I give you two US horror stories, and away we go. So while it’s taken me a few days, I wanted to respond to her piece, and add some other thoughts.

So, point by point, using the Prospect’s structure (The 10 Dumbest Arguments Against Health Care Reform), in order:

What we really need is a “bipartisan” health-reform bill — and if Democrats act properly, they could get one.

Anna-Lisa and I both agree with the Prospect that this is essentially bogus. The quality of the reform is what matters.

Whatever we do, we shouldn’t ruin “the best health-care system in the world.”

The Prospect’s point is that, by any objective measure, the results of our health care system are far from the best in the world. AnnaLisa focuses on the equally true, but not as systemically relevant, high-end quality of US health care, and is concerned that we not disincentivize innovation and advancement in medical techniques and technologies. But she loses me with the thought that if

…we could get rid of a lot of the regulations that exist right now, consumer choice and competition between companies would be increased, there would be more differentiation between insurance providers and plans, and we’d be free to pick cheaper ones with less coverage, more expensive ones to make us feel safer… basically, there would be more variety. Competition makes prices go down.

As Talking Points Memo has reported, one of the biggest obstacles to health reform is the lobbying power of insurance companies in states where they have a near monopoly in the insurance business. The so-called “Public Option” is designed to specifically address this market domination, and create competition.

By the way, nothing in current reform proposals would prevent the very rich from getting as much treatment as they like, and research grants (which AnnaLisa mentions as an ongoing necessity to spur innovation and technological/treatment advancements) are not going away.

This health reform is moving too fast.

The Prospect points out that people who are trying to slow the process are the ones who oppose it; AnnaLisa suggests that doesn’t address the quality of their arguments.

But saying “slow down” doesn’t address the quality of a proposal, either. The way to engage on health care reform is to address a concern, and either work it out or not. If it’s a substantive, sincere concern, then addressing that concern may, in fact, slow down the process.

Republicans and Democrats have fundamental disagreements on how to reform health care, and most of those disagreements are unresolvable. I’m all for good-faith engagement, but the reality is that those saying slow down are hoping to push reform into 2010, when midterm elections will keep anything from happening. The “go-slow” argument is a Trojan horse, and has nothing to do with the merits of the bill – which is why it’s a dumb argument.

If we can find an anecdote about a Canadian or Brit who had an unhappy medical experience, that means we shouldn’t reform our own system.

The Prospect points out that reform isn’t taking us towards either the Canadian OR British systems, and is irrelevant.

My problem is that anecdotes make for bad arguments by themselves; their value is in illustrating demonstrable trends.

AnnaLisa sees these anecdotes as cautionary tales, and they demonstrate that various health care systems all have their weaknesses. I understand that point, but given that all systems have weaknesses, you should try to find the system that serves the most people at a minimum standard of care for the least cost. The American system fails on all three counts.

If this health reform passes, some bureaucrat might be able to dictate what care you can get, standing between you and your doctor.

Th Prospect points out (as I have) that there’s already a bureaucrat between you and your doctor, only this time it’s one whose profits increase by denying you treatment.

AnnaLisa suggests that the government “doesn’t exactly have a track record of less bureaucracy than private companies.” But, as far as health care administrative costs go, that’s not true. And, as someone who had wrestled with insurance companies to get coverage and get paid, I can tell you their bureaucracies are pretty well developed.

Reform is all well and good, but we need to make sure it doesn’t increase the deficit.

The Prospect points out that this can be used as a palatable smokescreen for otherwise ideological opposition to reform. AnnaLisa rightly points out that deficit concerns aren’t trivial (I agree, but find that argument less compelling from folks who voted for the Bush tax cuts and the Iraq war, neither of which were exactly deficit neutral). But there’s a larger argument: reform costs money now in order to save more money later – at least that’s the theory. (Where we end up on that equation remains to be seen.) What it costs now is less important than what it does to change the cost structure of health care – bending the cost curve down, to use the parlance.

The Prospect also points out that Single Payer would save the most money, but no one carping about cost is proposing that as a solution.

If you can make a flow chart with lots of boxes and arrows on it, that means health reform will be terrible.

The Republicans created a fancy chart to show how convoluted some version of health care reform is. The Prospect points out that the GOP chart bears no resemblance to how individuals interact with their doctors, and Jon Cohn helpfully produces a similar chart of the current system. All of which is meaningless: the important relationships are between the doctor, the patient, and the insurer. The background stuff is irrelevant, except as it affects the foregoing. The chart’s implication – that all of a sudden people will have to deal with 20 bureaucracies to see their doctors – is simply untrue.

AnnaLisa warns against us saying reform will be “simple and easy,” but no one favoring reform is saying that. What they are saying is that a confusing chart isn’t relevant to the debate when it isn’t illustrative of how the process will work for the consumer.

If we could only make it illegal for people to sue when their surgeon amputates the wrong leg, we could get costs under control.

Putting aside the notion of whether it’s desirable to do that, there’s no evidence that it would lower costs substantially. AnnaLisa thinks this would help; the Prospect links to this New Yorker article about health care costs in McAllen, Texas, which are nearly double the national average, even though “tort reform” has reduced lawsuits “practically to zero.”

I have a friend whose knee was ruined by a post-operative infection that his surgeon advised him to ignore until Monday (this was on Saturday). He wisely ignored the doctor, and was in the hospital for three weeks getting courses of antibiotics and getting his knee flushed out twice. He is, literally, lucky to be alive. He has been in pain since – for over two years. The original surgeon dropped him – he was angry that his instructions had been ignored – and the current surgeon suggested that my friend sue. (He has real costs associated with this injury that are coming out of his – and his employer’s – pockets.) However, the current limitation on damages in California kept any lawyer from taking his case.

I think rather than a limitation on damages, protections for doctors who act competently according to proven effective procedures would help more. It would also help if the medical community policed itself. One study showed that under 6% of doctors were responsible for over 58% of malpractice claims over a 15 year period. As Ann Woolner says, Cap Medical Malpractice, not Malpractice Awards.

Reform might make me lose my current health coverage.

Extremely unlikely. Far less likely than the risk of losing coverage when you change or leave your job. The Prospect, AnnaLisa, and I agree on this one.

Health-care reform will literally kill you.

Part of this is that people will have to wait for life-saving surgery – which isn’t true in Canada, at least – and the other part relates to the argument that rationed health care, combined with strict government cost-benefit analysis, means that your life is assigned a value, and your treatment can’t exceed that value. The Prospect doesn’t specifically debunk the claim – of course, the claim is so vague as to be laughable – but nowhere in any bill is anything that sets up any kind of metric regarding the value of one’s life vs. one’s treatment. AnnaLisa says there’s a risk of people dying if wait times are too long, and I suppose that’s true, but there’s no solid evidence that will happen (see above), and we already have people dying in this country because insurance companies make the very comparison reform opponents accuse health reform proposals of mandating.


I know this is long, but there’s one more thing. In a prior post, AnnaLisa lays out an argument that health care isn’t a right. I fundamentally disagree with that notion, because I think the measure of a society is how well it provides for the least among us, and health care is one of the those things that is necessary for a minimum standard of living.

I doubt I will convince her, but I’d note that among the rights AnnaLisa claims we DO have are those in the preamble to the Declaration of Independence: life, liberty, and the pursuit of happiness. The constitution renders those rights differently, but essentially the concept is that the government can not infringe those rights without cause.

I think health care is a right because its absence impedes the achievement of the inalienable rights delineated in the preamble and because right now the government permits a system that denies those rights to individuals based solely on money and circumstance. But I also think, whether it’s a right or not, the system we have now is expensive and inefficient, that it reduces our productivity as a country and our competitiveness as an economy, and that it perversely allows individuals to profit through the denial of health care to others.

Tina Dupuy has a terrific piece on firefighting in the 1800’s – when fire departments were private and for profit. What could go wrong with THAT system?

I don’t know what will happen with the reform measures grinding their way through Congress. I do know this: good faith, honest arguments against reform are being buried alive by the seemingly endless fabrication and distortions being thrown at it every day. I think opponents make these arguments because, on the merits, they’d lose. If there’s another reason, they have yet to show me. But as their lies drown out the sincere concerns of people like AnnaLisa, rational and productive conversations about health care become more and more difficult.


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