Monday, March 3, 2008

Health Care

I was asked to include a post on health care, a subject that I am definitely not an expert in.

I think both the Hillary and Obama plans are a step forward. In that sense, I think that even some of Bush's ideas would have been a step forward, if they could ever be enacted.

After such a prolonged national stalemate on such an important issue, I think that debating the fine points either plan misses the point.

No president will be able to enact any plan that they propose as candidate, and it will take great skill to enact some small part of any of their plans. Given that both Hillary and Obama have very similar plans, who do you think will have the most chance of getting something vaguely resembling their plan accomplished?

On one hand, Hillary's argument that she has tried and failed at health care does have some merit. I generally do better at something the second time I try it than the first. The problem I am not sure she appreciates is that her first attempt failed due to her complete failure to build a political consensus. Holding Cheney style secret hearings is the worst possible way she could have built support. I just don't see the nation uniting around her proposals this time around. The only group she may hope to unite is the Republican party.

Obama would have some brief window of opportunity to pass something like his plan, a more modest and incremental plan than Hillary's. Obama seems to understand the immense difficulty he face trying to pass anything at all.

I haven't mentioned McCain's plan because he really doesn't have one. His plan is basically to give a tax deduction for health insurance. Brilliant. McCain advocates whopping $5000 a year tax deduction for families. Please tell me where even a small family can find insurance for $416 a month. Even if you could find a family plan for $5000 a year, I imagine a lot of middle class people just don't have that kind of money just laying around.

You have to ask yourself, does McCain even know how hard and expensive it is to obtain private health insurance? More importantly, I am sure he doesn't know why it is so expensive. Hillary, Obama, and even Mitt Romney know that healthy people, specifically the young, tend to opt out of the market. Others, such as the poor, can't afford a health insurance policy. That leaves private companies with a smaller pool of more expensive participants, and expensive emergency care for the rest.

This is my favorite gem from McCains proposal: " Promote competition throughout the health care system - between providers and among alternative treatments." Yeah right. Here is a true story. My newborn baby is vomiting every meal. We call the pediatrician, the pediatrician says it is probably best to go to the ER, just to be safe. We go to the ER and everything turns out to be ok after a 5-10 minute consultation with a doctor. Six months later, we have bills totaling about $600 from the doctor and the hospital. No tests, no drugs, no procedures. We have insurance, but there is a $1500/yr annual deductible so the bill come out of pocket. The McCain "plan" does nothing for us as we already have a tax deductible health care savings plan. If we had more competition, we could have called up all of the hospitals in the area first, asked them about how much they charge for a problem with our daughter that we don't know and she may or may not have. What we are really paying for that night, was all of the other uninsured people in the ER, the vast majority of whom will not run out and buy health insurance simply because they get a partial tax deduction for doing so.

From that perspective, I do have to give a small leg up to Hillary's plan (which she could never get enacted). Her plan requires universal participation, whereas Obama's plan only does for children.

In my ideal world, we would all be covered under the plan that member's of congress have, but so what? Without huge political capital and the ability to create a consensus, nothing will happen. We have been debating this my entire adult life, and nothing has changed, except for getting worse. I will vote for the candidate who has the greatest chance of doing something, anything, to improve health care in our country.

2 comments:

Eric said...

Where in the constitution does it mandate that the federal government must provide citizens healthcare? Given that the government has done such wonders with programs like Medicaid, Social Security and others what makes you think it would be better run by them than the private sector? Because they are always fair, always non-partisan and limit bueracracy? In 2005 Healthcare was 16% of the US GDP and it is projected to be 20% by 2015 - sound more like socialism or marxism to me. Isn't there someplace in between?

Steele Street said...

I don't see where you find a constitutional argument in my post. The government does all sorts of things that are not required by the constitution.

Call me a marxist or whatever, but I just think that healthcare will ultimately be a government function such as police, fire, etc. There will be large roles for the private sector, but we don't let people's homes burn down because they don't have insurance. That is essentially where we are today with health care.

I know government isn't always efficient, but if you really believe that insurance companies and hospitals are all that efficient, I will show you my $600 bill from a private hospital for a 5 minute consult that will make a $1000 toilet seat seem like a bargain!