One of the greatest dangers of socialism is the creation of a privileged class of wealthy political insiders who live under different rules than the rest of the citizenry.
Ed Morrisey suggests that Obama had a “Dukakis Moment” when he refused to say that he would leave his own family dependent on politically-managed health care. [h/t Instapundit]
I don’t think we should leave him any choice.
We should create a legal requirement that political elites have to use the same system they foist on everyone else. They should have to wait for hours in doctors’ offices. They should have to wait weeks or months for tests. They should be fobbed off on emergency rooms if they get sick over the weekend. They should be denied any Hail Mary test, medication or procedure. They should get the entire politically-managed health-care experience.
This standard should extend to all elected officials, political appointees and their immediate families.
Such a law would create a built-in feedback loop that would prevent politicians from ignoring the health of the people.
Here is the story that set Captin Ed off:
“President Obama Defends Right to Choose Best Care: In ABC News Health Care Forum, President Answers Questions About Reform” by Jake Tapper and Karen Travers at ABC News on June 24, 2009:
I agree with Captain Ed:
Of course Shannon’s idea will never fly. IIRC, the original Hillarycare plan made it illegal to commit a health-care outside the system. But, that could never be enforced without a comprehensive system for closing the borders, which, as every good liberal knows, is impossible.
Shannon, I think you’re on the right track but it should go even further, to a deeper principle: any law that provides any exception for the “important people” should be null and void. How you’d write such a thing, much less enforce it, is of course the problem. As Jerry Pournelle likes to say (though I’m paraphrasing here), “If there were a magic button that would give us good government, surely someone would have pushed it by now.”
Kirk Parker,
How you’d write such a thing, much less enforce it, is of course the problem.
It would be a condition of public office. All offices have obligations and requirements attach. Many of these impose on the office holders freedom. Currently Federal office holder must disclose their finances, submit to background checks, accept travel restrictions, etc.
I think it would be a simple legal matter to require the office holder to use politically-managed health. The courts would probably shoot down requiring spouses and children to comply.
The best option for real reform would be a program of fixed, indemnity-style, health insurance payments for services that would pay the basic charge but allow the doctor and patient to negotiate additional charges above the insurance payment. That is what works in France and the absence of which has doomed the Canadian system. Right now, we have physicians dropping out of Medicare because of low payment and excessive red tape. They are dropping Medicare and then serving Medicare patients on a cash basis. The busiest hip replacement surgeon in Newport Beach, CA is no longer a Medicare provider and charges $1200 for a total hip. I don’t know if he takes private insurance. The patient can use Medicare for the hospital but the surgeon has no relationship with Medicare.
The same is true of the only fellowship trained geriatric specialist in central Iowa. I met her at the geriatrics meeting in Chicago in April. She was being harassed by Medicare for wanting to see her elderly patients more often than Medicare allowed (the rationing that Obama denies will happen). Her decision was to drop Medicare and practice in a cash environment. I called Grassley’s office and suggested they find her and talk to her. Her entire practice is made up of Medicare beneficiaries but she doesn’t accept it.
The criminal penalties in Hillary’s plan is what doomed all physician cooperation. The left always is tempted by authoritarian solutions.
If they wait a bit longer, more and more market mechanisms will emerge as they are doing now. One of the great barriers to a cash market is the problem of fake “retail” prices in Medicine. Insurance pays a small fraction of that notorious hospital bill with the $50 aspirin. That is just for the rubes. Inflation of medical bills is a serious barrier to a real market but the guy in Newport Beach is charging Medicare patients what Medicare actually was paying him, not what he was billing. If you remain a Medicare participant, you can’t do that. They will discount your “profile” to the cash fee, then discount it 75% from that. Until we have true prices, we can’t have a market. We are starting to see that now.
Obama will probably wreck it.
Hi Michael,
Insurance companies do the same thing. If you have ever looked at your explanation of benefits letter from an insurance company, they pay a percentage of UCR (usual customary rates). The doctor has to charge cash patients higher to get paid what he should be paid from insurance.
The more BO talks, the more I think he is a droid, devoid of human emotion. Here is another quote from the ABC story I linked above:
But, as the infomercial says, wait, there is more:
“Obama discusses deathbed measures: At a healthcare town hall, he says stopping futile procedures for the terminally ill can lower costs” by Peter Nicholas in the Los Angeles Times on June 25, 2009:
If Obama-care is not dead yet, it has to be very close.
Nonnie, many of the hospital contracts do not tell the whole story on the EOB. They will tell you what is allowed but the actual payment may be confidential. Cash patients get screwed because, if the doctor charges a lower price and Medicare learns of it, they will lower his/her profile to that amount and the discount goes from that. Many doctors will charge uninsured patients a lower price but must keep it quiet. Hospitals will not do so as they are at greater risk. Remember the WSJ stories about Yale New Haven stories a couple of years ago ? Those poor patients were being charged retail even though Medicaid might have paid 10% of that bill.
Yes, under the current system cash patients get screwed. They have little negotiating power, because most prices are set in negotiation with big, third-party payers. And the physicians’ and hospitals’ administrative people often treat cash payers as troublemakers, even though such patients pay up front at top rates.
Shannon, I doubt that the limitations of socialized medicine will be felt by the members of our political class. Obama’s children will be treated just like anyone else, at a free clinic at the Naval Medical Center that for some reason has no wait and is staffed by the best physicians. In countries with socialized medicine the nomenklatura always get privileged treatment, whatever the rules.
Ultimately the only solution is to throw the bums out and radically shrink the govt.
Exactly right, Jonathan. As in Cuba – a single government run medical system which yet somehow manages to have two very distinct tiers. Or as in the old Soviet Union; the ‘special’ shops for the nomenklatura where proper western goods could be bought.
“We should create a legal requirement that political elites have to use the same system they foist on everyone else”
I like the sentiment, and would take it further: The political elites must always get lowest priority for care. Seems fitting in so many ways.
That said, I don’t think that your suggestion could work: Corruption always finds a way around the law.
“One of the greatest dangers of socialism is the creation of a privileged class of wealthy political insiders who live under different rules than the rest of the citizenry.”
How is this “socialism” different from what we have now? Can anyone say with a straight face that there is no “privileged class of wealthy political insiders living under different rules than the rest of the citizenry”?
What about the bankers and the financial class that make millions and millions of dollars while taking government bailouts because they work for institutions that are “too big to fail”? Meanwhile ordinary people are losing their homes to foreclosure and their jobs in a tanking economy.
And re health care specifically – the political class represented by Congress is reported to have secure affordable health insurance for life.
Highly paid lobbyists are donating millions to politicians whose ears they have. The health insurance industry is expensive to run, pays some executives exorbitant salaries and bonuses, makes profits for investors and leaves about 15% of the population completely uncovered. Why does anybody think it is wrong to provide all the citizens in a rich country with access to health care? Almost all other industrialized countries do so and have greater longevity. Isn’t it shameful for the US to have the highest per capita health expenditures in the world without taking care of everybody? The socialist European countries like France and Germany and the UK and The Netherlands etc etc etc are not having a health care financing crisis.
We should create a legal requirement that political elites have to use the same system they foist on everyone else.
While this is a laudable idea, it lets off the hook the politicians who think it’s okay for tens of millions of people to go without health coverage at all. These are people who have jobs (or got laid off), because the people who don’t have jobs for any length of time qualify for Medicaid.
Yeah, I don’t want the government to mess with people’s private insurance, but inaction is not exactly a victimless crime either.
I echo the previous two commenters. When first reading Love’s suggestion, I thought she was actually making a good point: if politicians were forced to live as those of us with basic coverage, they might have more incentive to support good policy. My family pays $950 a month for our lowest-tier Kaiser HMO plan and her description fits our level of care perfectly. Does she think that HMOs don’t ration service? Of course they do!
A conservative argument is often that we sacrifice too much for the public good (evidence often chases this premise). That is a moral philosophy, and to each his own. But in a private market, where what Love describes is a pretty standard level of service, I don’t see how a public option is going to be much worse.
And if it is, as I understand, it no one would be forced to choose it.
CJCG,
Can anyone say with a straight face that there is no “privileged class of wealthy political insiders living under different rules than the rest of the citizenry”?
Everything you say about the corrupt interactions between politics and large private enterprises is true so why do you think getting the politicians and business people even more intertwined will be even better? It’s like you’re pounding your hand with a hammer, finding it hurts and then deciding that more whacks will make it better.
“When government controls buying and selling the first thing bought and sold is politicians.” –P.J. O’rourke.
The logical goal would be to reduce the politician’s power over business so that business won’t care as much what government does.
Why does anybody think it is wrong to provide all the citizens in a rich country with access to health care?
Nobody thinks it’s wrong, we just don’t think the magical government fairies that produce high levels of care at low cost exists. People like the Chicagoboyz are people with a very detailed understanding of how complex the world is and how difficult it is to centrally organize medical care for 300 million people. We are concerned how a politically-managed health care system will allocate resources. Will it do it based on sound science of the latest media fad? How will it impact medical research? If we can’t get such a system to work on the state level or with the politically-managed health care we have now, why do you think we will be able to do so on an even larger scale?
Almost all other industrialized countries do so and have greater longevity
This is not true. When you correct for ethnicity and difference in data collection, the same ethnic groups in America live as long or longer than similar people living under socialized medicine. Outcomes for all major diseases are significantly better in America.
Isn’t it shameful for the US to have the highest per capita health expenditures in the world without taking care of everybody?
Everybody is taking care of. Can you name a single person in the U.S. who has died from a lack of health care? If such people existed don’t you think we would see their faces on every single Democrat advertisement? We take care of everyone we simply do so in a more decentralized fashion than Europe.
The socialist European countries like France and Germany and the UK and The Netherlands etc etc etc are not having a health care financing crisis.
Yes, they are. Medical cost in socialist countries are rising just as fast as they are in America. The major driving factor in health care cost is increasing life-saving technology. America simply has higher built in cost such as private rooms and higher salaries for health care workers. The rate of change is the same. If we let the politicians dictate our health care, the only way they can reduce cost is to deny us access to new technology. That is Dick Gephardt’s idea, the man whom Obama originally chose to spearhead his health care policy before he got busted for corruption.
Politically-managed health care isn’t about improving health. Ordinary people support politically-managed health care when they value security over freedom and innovation. Politicians support it because it will make people even more dependent on politicians. It’s not compassion it’s control.
Eli,
My family pays $950 a month for our lowest-tier Kaiser HMO plan and her description fits our level of care perfectly. Does she think that HMOs don’t ration service? Of course they do!
Yes, they do ration service (all goods and services are rationed) but with a private system you get to chose what is rationed by the company you buy insurance from.
But in a private market, where what Love describes is a pretty standard level of service, I don’t see how a public option is going to be much worse.
Then why not place absolutely everything under political control? If the politicians can centrally manage health care for 300 million people, why can’t they manage absolutely everything? What is so magical about health care that makes it more easy to manage politically than whatever it is you do for a living (assuming you don’t work for the government?) Why don’t we just vote on absolutely everything?
And if it is, as I understand, it no one would be forced to choose it.
Obama has intentionally created a system with no firebreak between the private and public systems. Since private systems cannot compete with free care, the private systems will be driven into bankruptcy. We will end up with a system much like the education system in which most the population attends inferior politically-managed schools while the wealthy (and politicians) send their to superior public schools.
Like I said, one system for the politically connected, another for the rest of us.