Michael Millenson’s excellent and biting piece on the willingness of Orange Country Republicans to accept socialized fire departments has provoked great response. But of course this being America, even the concept of us “all being in this together” for a devastating disaster isn’t quite true.

Friday’s LA Times has an article about private home insurers running a “concierge-level” fire protection service for those in very expensive homes, and it appears that in some cases the intervention of the private firemen was the difference between saving a $3-5m home and it burning down like the one across the street.

There are obvious comparisons to the privatization of police forces—both the growth in special security companies and the over-staffing of police in tony towns compared to the under-staffing in poorer towns where there’s way more crime. And it does seem unfair that in the midst of the crisis some people got better treatment.

But I don’t think the private firemen completely defeat the concept of social insurance for health care. If you think about it, this is exactly what happens in the UK. Everyone pays into the pool according to their ability to do so. No one is sent a bill for fire protection or health care from the socialized provider, whatever their need. But in the UK and in many universal insurance companies countries, you can trade up to buy supplementary insurance that allows you to jump the queue in certain cases—a little like having the private fire guy come and spray extra retardant on your roof. But the main fire department will still be the ones coming to try to save your house when the fire actually gets into your backyard.

Of course the danger here is that everyone of any means gets the private fire insurance, and then decides that they don’t need to pay for the socialized fire department. Then, if you can’t afford private fire insurance, your house will be left to burn down—while what’s left of the underfunded socialized fire department does its best while overwhelmed by demands from the rest of the poor saps who couldn’t afford private coverage.

And that’s essentially what we have in health care now.

At the moment, nearly everyone interested in the S-CHIP debate is focusing on October 18,  the
day the US House of Representatives will try to override the President’s veto of an expanded State Children’s Health Insurance Program (SCHIP).

Unlike many of the critics, I favor the expanded program.  Briefly, here are a few things to
keep in mind: 

First, under the proposal, 70%  to 80% of children in the program would be from
families earning less than twice the poverty level ($20,650 for a family
of four).   

Granted families
of four earning  up to $60,000 a year would qualify for the program
in most states. But given the fact that the average annual premium for
family coverage is now pushing $13,000, it is not at all unreasonable
to suggest that families earning $$60,000 before taxes cannot
afford private insurance.

In theory,
maybe these families could buy private insurance just for their children,
but it’s hard enough to buy individual coverage (when you don’t
belong to a group) –try finding individual insurance that covers
children only.

Continue reading…

Yes, that headline is a blatant attempt to get some of the opprobrium Malkin and her nutty commenters are venting on Jon Cohn and Erza Klein.

A little background. Jon, being the sensible moderate, wrote a good article on why the SCHIP veto helps Universal Health Care, and then pointed out that the smearing of the kid from Baltimore whom the Dems put up to support S-CHIP was a dumb idea with lots on the far right failing to do basic fact checking. In fact the family in question was exactly the type that S-CHIP needs to help

In the NY Times today Paul Krugman puts this all into a little more narrow perspective. Suggesting that sliming Graeme Frost–the 12 year old kid in question, is just standard operating procedure for the Rush Limbaugh-types on the right, who have a pretty direct line into the Republican machine.

Continue reading…

I wanted to call it “Hillary Clinton meets Ann Rand,” but my Spot-on Editor decided that she really liked the notion of privatizing the fire department. So I’m up over there dissing on the The Garden Hose Health Care Brigade.

As ever come back here to comment.

I began teaching health policy almost thirty years ago with Odin Anderson at the University of Chicago
Graduate School of Business. Like me, Odin was a sociologist, and one
of his hobbies was tracking the sociology of our nation’s “healthcare
crisis”.  He found that the health care “crisis” waxed and
waned (as measured by press mentions and journal articles), but never
disappeared.   It had been going on for twenty years by then,
so I guess we’ve now been in “crisis” for fifty years.  The
American health care “crisis” is not acute illness – rather it is
like a chronic disease which flares up periodically, accompanied by
fresh prophecies of impending doom and calls for someone on a white
horse to fix the problem.

From 1970 to 1993, health costs
roughly doubled as a percentage of GDP. All the way along, prophets
of doom  forecast that the country would simply fall apart when
health costs exceeded 8%, then 10%, etc. .  Our economy somehow
continued growing and innovating, and the health system  got steadily
more capable at managing our illnesses the entire time. No-one 
I know would trade our present, very expensive health system for the
cheaper one we had in 1965 or 1980. 

Then, during the mid- 1990’s,
a remarkable thing happened.  For the first time since people began
tracking the statistic, health costs remained dead flat as a % of GDP
for eight years in a row.  It is remarkable how little attention
this flattening got from the “crisis” mongers.  When we finally
get this year’s spending numbers from the CMS Actuary, my forecast
is thathHealth costs will have been flat as a percentage of GDP for
the past five years if you include 2007.  Five years isn’t “momentary”,
as Brian Klepper characterized this latest pause.

Continue reading…

John Graham at Pacific Research Institute is obviously looking for trouble. So he invited two people who really don’t get on — at least in their online comments on THCB — to come comment about Sicko and the Canada-bashers response. I’ve of course had my say about both Sicko and the Canada-bashers before.

So if you want to see me square up to Logan Clements (who is replacing Stuart Browning, who’s cried off sick) hopefully figuratively and not literally, come down to the Pacific Design Center in West Hollywood (Los Angeles) on Thursday September 27th. Stuart and Michael Moore (by proxy) will be showing why making anecdotal poorly researched movies actually changes health policy for better but mostly for worse, and I’ll be explaining why neither of them would recognize real research if they tripped over it in the street.

The info is here–Sicko and its malcontents

I think I’m supposed to be defending Moore, by the way. But perhaps John will step into that void. Local LA Pol Bill Rosendahl will be refereeing! Should be fun!

Meanwhile see how many ridiculous claims and outright irrelevant rubbish you can find in the trailer in the Sicko reply under construction. It’s up on Clements’ site.

That should get the juices flowing