POLICY: Another dribble on the single payer versus voucher issue

There’s an interesting set of six letters about Krugman’s article in the NY Times.  One of the letters is way off base, suggesting that Medicare limits what doctors can and can’t do.  Well I suppose compared to a cash paying gazillionaire that’s true, but anyone who knows anything about private health plans know that they are much tougher on limiting access to different types of care and different drugs than Medicare (not that it’s done without good reason sometimes, but as my other post this morning shows sometimes there may be no good reason). The writer wonders whether Teddy Kennedy would want to be on Medicare. Unless I don’t understand Senators’ health plans, I assume he already is, and Krugman surely will be if he doesn’t get assassinated by the loony right. It beggars belief how the Times can publish that sort of uninformed tripe which contains not one iota of evidence, but then again it never published my brilliantly argued rebuttal to a letter from AHIP’s President about a previous Krugman column.

But one of the other letters is rather more interesting.  It says"

I find Paul Krugman’s column disturbing. If 72 percent of Americans want a national health insurance program but insurance companies have the power to override that majority, what does that say about the health of our democracy?

Where can we get insurance for such an ailment?

Glenn Alan Cheney, Hanover, Conn.

Basically Mr Cheney is right. People like his namesake the VP have proved time and time again that access to power can be bought by moneyed special interests — after all we still don’t know and probably never will exactly what went on in those meetings about the energy bill, but it’s pretty damn certain that Enron execs were writing US energy policy up until the moment that they just had to be repudiated.

However, I do have to take issue with the numbers quoted.  Essentially Krugman is quoting a number that has stayed relatively constant in various surveys, and crosses party lines.  The number is basically those who would in theory support universal health insurance.  These numbers are though not very important. A much better number is those who answer the three part question Harris has been asking for 20 odd years.  That question adds in the other part to "supporting universal insurance" by asking about the amount of change required in the system.  The three answers are broadly a) very minor change required, b) substantial reforms required, and c) complete rebuilding required.

The important answer is how many people are looking for a complete rebuilding. Because if there isn’t a substantial group in favor of that, none of the reforms required to get to universal insurance can happen. That number tends to hover between 20% and 30% (and by the way it’s way higher here than in any other English speaking country, which gives the lie to those saying that foreigners dislike their systems as much as Americans dislike ours). During the early days of the Clinton Administration, the "completely rebuild" number got up to over 40%.  More recently it also got into the higher 30s.  But for an Administration or Congress to have the will to defeat the special interests on health care, that number needs to be in the 40s or even 50s and stay there for a while. We haven’t seen that, which is why we haven’t seen real reform.

It will come, but the question is, how long will it take for things to be bad enough to drive enough Americans into the "completely rebuild" camp?

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3 replies »

  1. The problem is the cost of uninsured isn’t zero.
    Consider our tax base. Most people who pay taxes and own property are employed or have retired. Many of these have health insurance and bear the cost of the increased medical expense through cost-sharing on premiums, co-pays, deductibles and exclusions. They also bear the cost the uninsured through cuts in benefits and/or salary by employers overburdened with insurance/healthcare costs. As taxpayers they see tax increases in property and income tax related to government subsidies which cover costs related to medical treatment for people who are uninsured and can’t afford to pay. As the costs of being financially responsible and staying insured increase, many more people are choosing to drop out of the insurance pool and just take their chances, adding to the problem. In short, we are already paying to provide some level of national health insurance, but our patchwork system is not coming close to equitably spreading the costs and the spirling costs of the covered are shrinking the pool. We are paying now and will eventually pay more later.

  2. Mr. Cheney’s letter is interesting because it highlights the widespread confusion over health insurance. He points out, what you say have been, very constant political numbers and concludes that our democracy is sick. He wants a remedy for this perennial political problem and asks, “Where can we get insurance for such an ailment?”
    Insurance to protect against a predictable event? There is no such thing. Insurance is the mitigation of risk. Mr. Cheney either made a mistake or doesn’t understand the word. Yet, this is the larger problem: people hear and say national insurance, but, by economic theory, it’s something altogether different they’re supporting; something more like complete government funding of a major part of the economy, which leads inevitably to planning of its production process because money is the liaison between all producers and all inputs. And as Nobel Laureate F.A. Hayek writes in the 7th chapter, 9th paragraph of his famous work, The Road To Serfdom, control of production is tantamount to control of all choices in an economy.
    I want better healthcare at increased quality and lower prices, and I want to extend access to it to more people as much as anyone. But this is not the way.

  3. I don’t think Krugman has much to worry about from the “loony” right. The last time the Democrats had the White House and both Houses of Congress they lost their majority over this very issue.
    The summary of HR 676 states: Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this act. Allows such insurers to sell benefits that are not medically necessary, such as cosmetic surgery.
    Authorizes appropriations and provides for appropriated sums to be paid for: by increasing personal income taxes on the top 5 percent income earners, by instituting a new payroll tax and instituting a new tax on all stock and bond transactions.
    Krugman forgets that the Republicans control the White House and both Houses of Congress now. This legislation doesn’t have a chance.
    In Canada the courts have just ruled that “outlawing” health insurance is unconstitutional.
    So the Democrats better go back to the drawing board.