Home › Blogs › Jon Henke's blog ›

Medicare for All, Tax Hikes for All

Submitted by Jon Henke on Mon, 08/11/2008 - 17:33
in

Paul Krugman makes an argument that we're going to see again and again in the health care debate...

The politics of guaranteed care are also easy, at least in one sense: if the Democrats do manage to establish a system of universal coverage, the nation will love it.

I know that’s not what everyone says; some pundits claim that the United States has a uniquely individualistic culture, and that Americans won’t accept any system that makes health care a collective responsibility. Those who say this, however, seem to forget that we already have a program — you may have heard of it — called Medicare. It’s a program that collects money from every worker’s paycheck and uses it to pay the medical bills of everyone 65 and older. And it’s immensely popular.

I suspect this argument isn't entirely wrong.  OECD countries who have universal health care generally do like their health care systems.  And since we're dealing with taking away some of the visible, tangible costs from consumers and replacing them with less visible secondary costs or moving them into the unseen future, it's not at all implausible that the public would like it.

After all, we are not choosing between government-managed health care and free market health care, but between government-managed health care and...a different form of government-managed health care.  The Right would  love to defend free markets in health care for various good philosophical and economics reasons.  Instead, we end up defending the status quo, which has rather less to recommend it.  That's not a good place for us.

However, there are three problems with what Krugman claims about Medicare being "immensely popular"...

  1. The recipients of Medicare get it, basically, for free.  Since they're not paying for it at the point of purchase, it's not surprising that they think it's quite a nice thing.

  2. Indeed, a lot of the real costs of Medicare lie in the future.  And they are enormous.   The costs are being hidden for now, while voters mostly approve of the more tangible benefits.   Should voters ever have a chance to make a real cost/benefit trade-off, we'll see just how much they actually value it.  

  3. But, you might argue, polls show that 76% of Americans approve of Medicare.  And so they do.  But look what else those polls show about public approval of Medicare...

Rating the Performance of Nine Government Services

Q: "How would you rate each of the following government programs and services?"

October 2005 results

Base: All Adults

   

Excellent

Pretty Good

Only Fair

Poor

Positive

Negative

National Defense

%

10

35

34

21

45

55

Foreign aid

%

10

34

37

20

44

56

Food stamps

%

2

31

44

23

33

67

Unemployment benefits

%

2

30

44

23

32

68

Emergency services

%

4

28

38

29

32

68

Medicare, the health insurance program for the elderly and disabled

%

2

25

39

34

27

73

Social Security

%

3

24

40

34

27

73

Federal aid to public schools

%

3

23

40

34

26

74

Medicaid, the health insurance program for people with very low incomes

%

2

24

42

33

26

74

 

73% of adults rate the performance of Medicare negatively.  That's a remarkable number.

Of course, Paul Krugman and the Left have a remedy for that.   It involves astronomical increases in your taxes.  In 2005, Paul Krugman said the US "should be getting 28% of GDP [gross domestic product] in revenue. We are only collecting 17%."

That's around a 50% increase in taxes.  How will the public like that part of the equation? 

5
Your rating: None Average: 5 (1 vote)

Comments

Unfortunately It Will Be Popular With Most Americans

Submitted by Jeff Roberts on Mon, 08/11/2008 - 18:47.

An entitlement like Universal Health Care will be popular (with a majority of voters), expensive, and impossible to take away.  And just like every other government entitlement, 20% of taxpayers will be paying most of the cost for the other 80%, that's why it will be popular.

Add that to the litigious nature of America's legal system making sure every American gets every health care need met, and you'll have to double taxes to pay for it.  Americans won't see the true costs of "free" health care, they just know they no longer have to cut out a $600 check to the insurance company every month for their family.

So many people want "free" health care.  It used to just be the really poor, but now it's also the middle class and large companies because costs have gotten so out of control.  Republicans need to go on the offense with this issue by offering plans of their own.

What irritates me is when conservatives threaten to abandon the Republican Party because some congressman tried to get a highway project built in his district. That kind of spending pales in comparison to the universal health care Obama and the Democrats are proposing.  We need to keep our focus on the big picture, socialized medicine will break this country if it's passed.

absolutely

Submitted by Big Ben 4 liberty on Mon, 08/11/2008 - 20:53.

Everyone uniformed idiot who thinks this will mean actual free healthcare (i.e. any economic illiterate who doesn't understand the principles of TINSTAALF) will love it.  But when we have rationing of services, waiting lines, political shenagans to get those favored interest groups at the head of the line and reduced capabilites at our hospitals then people will actually demand even more consfictory taxes to kill our economy in a futile effort to improve this "free healthcare".

healthcare

Submitted by mnmod on Tue, 08/12/2008 - 08:18.

What is the conservative plan for the 47 million  (15%)  of Americans who lack health insurance?  Also as the movie Sicko documented even those with insurance  have many problems receiving needed care. Providing health care through the free market works especially well for insurance company executives as this (somewhat dated) chart shows:

http://www.managedcaremag.com/archives/0109/0109.compmon.html

Here's a more recent article of who benefits from our healthcare system and modern capitalist system.  Mcguire had to pay back nearly half of his $1.5 billion in stock options.

http://www.nytimes.com/2007/12/07/business/07options.html

 I can't recall reading about similar compensation or scandal with top administrators for the social security system.

 

 

 

What is the conservative plan

Submitted by Jon Henke on Tue, 08/12/2008 - 11:11.

What is the conservative plan for the 47 million  (15%)  of Americans who lack health insurance?

I can't speak for conservatives.  My plan would be to create more service differentiation and access levels.  It's absurd that we have to see a Doctor, with 10 years of medical training, to get an ear infection diagnosis.  It's absurd that we don't get the same tax breaks as businesses when we buy health care.  It's absurd that there are so many regulatory and licensing limitations on insurance and medical care. 

I also don't think we need a centralized "plan" to fix every problem.  Those tend to be much better at shifting the costs than at actually resolving problems.

I can't recall reading about similar compensation or scandal with top administrators for the social security system.

If I tried to do privately what SS does publicly, I would be thrown in jail.  You don't see those stories about Social Security, because they've legalized this one, particular Ponzi scheme.   And created accounting tricks to hide the long-term fiscal problems.

You do, however, see scandals, waste and fraud in the Medicare/Medicaid area.  Quite a lot, in fact.

Direct healthcare cost reduction

Submitted by Freedoms Truth on Tue, 08/12/2008 - 12:32.

My plan would be to create more service differentiation and access levels.  It's absurd that we have to see a Doctor, with 10 years of medical training, to get an ear infection diagnosis.  It's absurd that we don't get the same tax breaks as businesses when we buy health care.  It's absurd that there are so many regulatory and licensing limitations on insurance and medical care.

I agree 100%, and in my other comment noted that the GOP can and should own the issue of healthcare cost reduction. They #1 and #2  ways to reduce costs is deregulation and litigation reform. Democrats are constitutionally incapable of competing there.

Gingrich has been good in this area. Here is one idea: Require healthcare facilities to publicly post their prices. Suddenly people can shop around!

You do, however, see scandals, waste and fraud in the Medicare/Medicaid area.  Quite a lot, in fact.

This is all due to a system build on 3rd party payers. It creates red tape, unjust outcomes, huge cost overheads, waste, fraud and abuse.

We need food more than we need health care but we dont have 'food insurance' crisis. We just have most of us who buy our own food, and some on food stamps.

 

 

Universal Health Care, a Republican failure

Submitted by davidfarrar on Tue, 08/12/2008 - 09:56.

Since the nation is now poised to accept some form of Universal Health Care, I feel strongly compelled to point out that if such is the case, we, as Republicans,  have only ourselves to blame. 

Ever since we disbanded the Public Health Service, we have stood by and watched the private health care monopoly do what every unregulated monopoly does, raise prices to their limits and beyond.

I firmly believe that every successful Democratic-sponsored increase in government is directly due to a failure in Republicans following their Republican ideals. The Universal Health Care initiative is just the latest example. Our public school system is another, although that is now beginning addressed to some degree by voucherification (sec), a Republican ideal.

But all is not lost. We, as Republicans, can address Universal Health Care. In fact, we can actually support Universal Health Care as a Republican ideal. Just as with our support of public school vouchers, we can support the creation of both a public and private health care provider system, competing against each other for and to the benefit of their clients, the public.

Of course, the devil will be in the details, but the Republican ideal of smaller, more efficient government can be accomplished with a Universal Health Care system by insisting that we all pay into the system, even when we are young and healthy, while also always providing a choice to the customer as to which system, public or private,  receives the "opportunity" to serve the client.

ex animo

davidfarrar

Positive encouragement of GOP on healthcare needed

Submitted by Freedoms Truth on Tue, 08/12/2008 - 12:27.

You've got to cut out the circular firing squad syndrome.  It's bad enough that we beat up on Republicans after they lose a fight - which is a bit like blaming the bank security guards for bank robberies. But now you are going beyond that silliness with blaming the Republicans before they fail you! ...

Since the nation is now poised to accept some form of Universal Health Care, I feel strongly compelled to point out that if such is the case, we, as Republicans,  have only ourselves to blame.

Honestly - you could have said what you say above in 1993!  Universal Healthcare was inevitable and some 'conservatives' blamed Republicans. Senator Phil Gramm ignored the detractors, stood down Hillary Clinton ... and it didnt happen. All at once, anyway. The fact that we dont have even more socialized healthcare is perhaps a testament to some amount of cohones among Republicans. Like when Bush vetoed the S-CHIP expansion, which was and is clearly a Democrat attempt to create an issue to run against Republicans.

The GOP has done a reasonably good job on this, considering the toxic politics of this "Democrat issue".

Just as with our support of public school vouchers, we can support the creation of both a public and private health care provider system, competing against each other for and to the benefit of their clients, the public.

Health savings accounts are the 'choice' answer as vouchers is the 'choice' answer on education. We need to be pro-choice (on everythng but killing preborn humans).

the Republican ideal of smaller, more efficient government can be accomplished with a Universal Health Care system by insisting that we all pay into the system, even when we are young and healthy, while also always providing a choice to the customer as to which system, public or private,  receives the "opportunity" to serve the client.

Yes. The Romney approach - end the free riders, and you can cover everyone with less cost than the current system. The numbers work, and its so much better than 'single-payer' that it at least has moved the left's position into something more reasonable.  It has fans and detractors. Mandates are not the best answer though, unless you are throwing in the towel on Govt controls. Why should we force people to do that, if we can find a better way? Consider that:

1.  85% of people are already covered by insurance. 15% are not.

2. We have de facto universal care via the system that requires treatement of anyone in an emergency room.

3. The cost of health insurance is largely due to over-regulation. Solution: Allow people to apply for health insurance from any state. (McCain is touting this). Lower cost health insurance is possible - if it is reduced to catastrophic health insurance. What makes health insurance so expensive is that it has become like a credit card for everything you pay for in health care from braces to birth control.

4. You put your finger on the ultimate issue - the cost of healthcare itself! We should be having initiatives to lower the cost of key healthcare functions. Diagnosis, trips to doctors, basic hospital care, key services ... The GOP should 'own' the issue of lowering direct health-care costs ... by deregulation, litigation reform, and research in healthcare focussed on cost-reduction.  A 15% cost reduction could pay for universal coverage.

The 'uninsured' is 1/4 illegal aliens, 1/2 people who are young and healthy or otherwise chose not to have health insurance, and 1/4 people who fall through other cracks.

So deregulate health insurance and allow minimal coverage health insurance for the healthy and young, along with health savings accounts to make it easier to have some sort of minimal coverage.

And what if there are still uninsured, after we fix illegal immigration, lower health insurance costs, lower health care costs overall... then what?

We need to make the argument that if people have reasonable cost options and chose not to take them, then there is no problem to solve! Freedom works!

 

Double entry

Submitted by davidfarrar on Tue, 08/12/2008 - 13:37.

Deleted by author

All true. All true. But none will actually lower costs.

Submitted by davidfarrar on Tue, 08/12/2008 - 13:33.

There are lots of things Republicans should have done and could have done after Phil Gramm's defeat of Hillary's 1939 Universal Health Care effort.  But my point is, even if we adopt each and every Rommey proposal, none will be really effective as long as private health care providers enjoy a structural monopoly.

Now for my cojones joke:

Cojones de Toro...

A big Texan cowboy stopped at a local restaurant following a day of drinking and roaming around in Mexico. While sipping his tequila, he noticed a sizzling, scrumptious looking platter being served at the next table.

Not only did it look good, the smell was wonderful.

He asked the waiter, "What is that you just served?"

The waiter replied, "Ah senor, you have excellent taste! Those are bull's testicles from the bull fight this morning. A delicacy!"

The cowboy, though momentarily daunted, said, "What the heck, I'm on vacation down here! Bring me an order!"

The waiter replied, "I am so sorry senor. There is only one serving per day because there is only one bull fight each morning. If you come early tomorrow and place your order, we will be sure to save you this delicacy"!

The next morning, the cowboy returned, placed his order, and then that evening he was served the one and only special delicacy of the day.

After a few bites, and inspecting the contents of his platter, he called to the waiter and said, "These are delicious, but they are much, much smaller than the ones I saw you serve yesterday!"

The waiter shrugged his shoulders and replied, "Si, Senor. Sometimes the bull wins."

ex animo

davidfarrar

Americans like their health care

Submitted by Freedoms Truth on Tue, 08/12/2008 - 13:33.

OECD countries who have universal health care generally do like their health care systems. 

Americans like their own healthcare. They like their doctors etc.

On the other hand, I find it interesting that in a poll one month after Katrina and incessent bashing of FEMA, the Medicare system was rated lower than emergency services.

Medical Privacy

Submitted by Big Ben 4 liberty on Tue, 08/12/2008 - 16:11.

Another point we should consider is that Americans love their Healthcare privacy (i.e. the gubamint can't stick its nose in your medical records like the IRS does with your personal finances so its knows how much you made last year).  That privacy would obviously disappear when we have universal heatlh care because the new Federal Healthcare Bureaucracy would have full access to that information so as to determine if you are able to get any doctor prescribed treatsments.  You know if you engage in risky behaviors like smoking, extreme sports, if your overweight, or have been treated for drug addiction, your over 55 etc. which might lead them to determine that your low priority.

why doesn't everyone support universal healthcare

Submitted by mnmod on Tue, 08/12/2008 - 17:36.

according to story on NPR countries with universal healthcare have better outcomes at lower costs. What's not to like (unless you are one of the few enjoying big profits.)

 the untited states  ranks 29th in the world in terms of life expectancy and at or near the bottom of most international health care comparisons.

and we spend twice as much per person and cover only 85% of citizens

http://www.npr.org/templates/story/story.php?storyId=92136549