POLICY: Why dishonesty rules in our health care “debate”

Bush has certainly been attacking Kerry on his health care program. Jonathan Cohn is an editor at the New Republic who specializes in health care and is currently a Kaiser Family Foundation media fellow. For those of you who don’t track the political leanings of the weeklies, the New Republic is the Clintonian Democratic magazine, way to the right of the leftish The Nation, while far to the left of the conservative National Review. Cohn’s latest piece has been reproduced on CBS web-site which may (or more likely may not) hint at whom CBS’ parent Viacom wants to win the election.

In any event he does a much better job than Kerry has done himself on crying bullshit at Bush’s attempt to call the Kerry plan a government takeover of health care. In the article called A Guide To Bushspeak On Healthcare Cohn says:

The Clinton health care plan really was a government-run health plan (albeit one that was hardly the menace its critics warned it would be). That’s simply not the case with Kerry’s health plan, for reasons that I (among many others) have already written about. Today, in fact, a group of 68 health care policy experts led by Mark Peterson at the University of California at Los Angeles, released a petition calling upon the Bush campaign to end its gross distortions of Kerry’s plan. “Although Senator Kerry’s proposals should be subject to a full analysis of their cost and impact, any claim that they amount to ‘government-run health care’ or a ‘government takeover’ of the health care system or of health care decision-making is simply inconsistent with the facts. We are not aware of any expert in health care or health care finance, whatever his or her political orientation, who believes otherwise.”So why would Bush produce an ad like this – and continue to raise the specter of “government-run health care” – even though the charges are now widely known to be false? Because he keeps getting away with this dishonesty.

Meanwhile the 68 academics that Cohn quotes as opposing the Bush rhetoric represent a middle of the road group of health care economists. The only notable exceptions are Alain Enthoven of Stanford (although his one time colleague Richard Kronick is in the group) and Mark Pauly of Univ. Pennsylvania, the foremost defender of the status quo of the healthcare market. It’s also missing a certain (ex) Stanford Business School professor called Mark McClellan, who’s written extensively about health care and seems to know a thing or two about it. He might want to want to sign this too, but I think his boss might be a little unhappy with him!

Part of the problem is that both sides get their say on the talk shows, with no one (aside from the Columbia Journalism Review or John Stewart) being able to say “this is true — that isn’t”. On a personal note I tend to be able to demolish many arguments I meet with from people complaining about, say, Canadian health care or how inefficient the government program would be, by quoting referred studies that tell the truth. (It’s good to be a researcher wonk when these arguments come up). But there are two problems. One is that a well-financed opposition can cite its own fake studies, and two, no one gives a dam about studies when they have their own fears and anecdotes to back them up.

Hence I’m told again and again that government healthcare would be inefficient (as I heard from a Democrat I met tonight), despite the fact that Medicare’s admin costs are 3% while private insurance’s costs are 8-15%. You’d think that the onus would be on the defenders of the staus quo to show why a change would be worse. But instead–and I realize why–Kerry is running away from any program that could be described as a “government takeover”, even though a rational candidate should be able to defend it. And if I hear Bush say one more time that we have the best healthcare system in the world…..well to say the least he needs to be told by someone that there is a difference between having the most technologically advanced medical spottily applied, and having the best health care insurance and delivery system. There’s a reason we’re ranked number 37 by the WHO, and it’s not just that they’re a bunch of cheese-eating surrender monkeys.

Believe it or not, there’s a very detailed and fair explanation of the Kerry plan by the Heritage Foundation (they of the vast right-wing conspiracy) which goes through it line by line. Heritage of course prefers a consumer-based HSA-type system and (as debated ad nauseam on THCB) as that’s not part of the Kerry agenda they don’t approve. But despite their many criticisms of the Kerry plan, they represent it mostly fairly, unlike their friends on the Republican national committee and at the AEI. They say:

Based on independent estimates, it appears that the Senator’s proposals would significantly increase federal health care spending while sub­stantially reducing the number of Americans who are without insurance coverage. At the same time, he would refrain from undertaking any substantial reform of either private health insurance markets or government health care programs, including Medicaid.

Another detailed commentary on the plan comes from Jeff Lemieux at Centrists.org. Lemiuex’s extremely long examination of the plan suggests that it could be basis for bi-partisan reform to the system, as it relies on a mix of government and private action (or liberal and conservative ideas).

While I’m increasingly convinced that Kerry will win a very close election, I’m inclined to doubt that he’ll get anything like his plan past a Republican house and a very evenly divided Senate. So his plan is a starting point which may–if anything passes and that’s a longshot–work to get more people at the bottom into public programs, allow those in the middle to buy into the FEHBP, and slowly implement DSM programs and other cost saving methods into a more regulated private sector (and hopefully into Medicare too). But it is a long way from being a government dictated-system like that of Canada or the UK. Given the record of American private health care, that may be a bad thing. But the point is government-run health care can’t survive the political rhetoric here. It would be nice if just occasionally Bush would talk something akin to the truth about this issue, but then again why break a 4 year habit?

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