April 12, 2024

Follies of Health Care Centralization

The Congressional Budget Office says that Senator Max Baucus’ draft of a health care reform bill including a public option for health insurance will reduce the federal budget deficit by $81B over 10 years.  Not bad, if true, and that remains to be seen.

Republican leader Mitch McConnell labeled the CBO report “irrelevant.”

“What matters is that the final bill will cost about a trillion dollars, vastly expand the role of government in people’s healthcare decisions, increase premiums and limit choice,” he said.

Meanwhile the federal government’s deficit for FY 2009 has been announced, weighing in at an eye-popping $1.4T.  Given that, the CBO’s numbers are, frankly, less than trustworthy. 

Moreover, Congress’ natural and oft-observed inclination to expand and inflate welfare programs leads me to believe that the estimate is inaccurate by a substantial amount.

Finally, Let’s be clear that $81B is a lot of money.  But – and this is a big one – compared to the massive spending Democrats have already engaged in, as well as the upcoming years’ even bigger budgets, the $8B per year don’t amount to more than spit in the ocean. 

It’s a bad joke for Democrats to pretend that their health care agenda will ever provide a single dollar of savings.  How stupid do they think we are?  Truth is, unfortunately, that there are millions of people who either want to be fooled or simply don’t care about the lie.

As he’s demonstrated repeatedly, Ezra Klein is one such individual

the Democratic leadership is considering a public option compromise that actually sounds pretty good:

Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program. …

But instead of starting with no national public option and giving state governments the right to develop their own, the newest compromise approaches the issue from the opposite direction: beginning with a national public option and giving state governments the right not to have one. …

How such a system would work is still being debated, according to those with knowledge of the proposal. But theoretically, the “opt-out” approach would start with everyone having access to a public plan. What kind of public plan isn’t yet clear. States would then have the right to vote — either by referendum, legislature, or simply a gubernatorial decree — to make the option unavailable in their health care exchanges.

That gives you an essentially national administrative structure, but also gives states the right to reject the option entirely. It means, in other words, that the blue states get the public option at full strength and the red states get to ignore it entirely.

That’s a real improvement over Tom Carper’s proposal allowing individual states to create their own public options, which would would be quite a bit weaker than a national program.

That’s not necessarily true, unless by weaker Klein means not being part of a monolithic system.  There is no reason to suppose that a state program would be less beneficial to its participants than a federal system.  Presumedly states would be given money by the feds in a state-based environment; they could use it as they see fit to provide services in this model.

It also creates a neat policy experiment: We can see, over time, what happens to state insurance markets that include the national public option and compare them with those that don’t. We can see whether the worst fears of conservatives are realized and private insurers are driven out and providers are forced out of business due to low payment rates, and we can see whether the hopes of liberals are right and costs come down and private insurers become leaner and more efficient. Or both, or neither. It’s an opportunity to pit liberal and conservative policies against each other

Untrue.  Untrue.  Rather than being a “neat” experiment it creates a rigged game: (Blue) states that accept the federal plan gain resources that come from – or at the expense of – other (red) states.  They should then generate better outcomes in the absolute sense simply because they would get extra, unearned funds sent their way.  Meanwhile, the recalcitrant red states would be taxed and then left to their own devices.

If we are interested in experimenting with health care – and it’s far from a given that we should – Carper’s model of letting states do their own thing is far superior because it provides 50 laboratories in which to plan and innovate.  No federally-controlled program can match that, particularly a massive, complex program that’s an order of magnitude larger than the debt-ridden Medicare program.

In fact, what’s really important to lowering costs of health care insurance is giving consumers options.  Right now most people who have insurance get it from their employers and have very little actual choice in what they get for their money.

A better solution would be to have employers give their workers cash-in-hand with which to purchase their own policies on the open market.  The consumer health insurance market should be deregulated such that artificial boundaries such as state lines so that insurers can compete in every locality without restriction.  Government regulation should be used to level the playing field between insurers in terms of eliminating pre-existing conditions and participant cherry-picking, instead of not constraining competition geographically.

The bottom line is that more choices in the hands of individuals is what leads to low-cost outcomes, not the creation of a massive bureaucracy in Washington.


Marc is a software developer, writer, and part-time political know-it-all who currently resides in Texas in the good ol' U.S.A.

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