Conservative Origins of Obamacare

Romneycare, is a three-legged stool of regulation and subsidies: community rating requiring insurers to make the same policies available to everyone regardless of health status; an individual mandate, requiring everyone to purchase insurance, so that healthy people don’t opt out; and subsidies to keep insurance affordable for those with lower incomes.

The original Heritage plan from 1989 had all these features.

These days, Heritage strives mightily to deny the obvious

From NYTimes.com

Heritage declares we have always been at war with Eastasia.

We’re All Rationers

Certainly telling seniors to buy all their own health care is a complete political (and ethical) non-starter. But telling seniors to pay for more of their own health care — well, it’s hard to see how else we can hope to reduce Medicare’s fiscal burden. Maybe the premium support/voucher model that the Ryan budget proposes isn’t the optimal way to do it. But every other mechanism for serious cost containment leads inexorably to a similar place.

This is obvious when you think seriously about the main Obama administration proposal for Medicare reform — the famous IPAB plan, which would put a board of experts in charge of deciding which treatments Medicare will and won’t cover. If it had any deficit-cutting teeth at all, such a board would constantly end up asking seniors to pay for their own health care (or else go without it), by refusing to pay for treatments that doctors would otherwise prescribe.

From We’re All Rationers

Mr Douthat is right here. There is no form of cost control that is not also a form of rationing. Anyone that is pro-cost-control but anti-rationing doesn’t understand the problem.

Congress Readies To Mobilize In Favor Of Wasteful Medicare Spending

the very same members of congress who voted this month to privatize Medicare in 2022 and enact draconian cuts throughout the 2020s and 2030s are here in town right now defending health care providers’ right to charge the government high prices for services that don’t work. Indeed, as recently as 2009 no less a figure than Paul Ryan himself was fuming at the idea of reducing government subsidies to for-profit insurance companies.

From Congress Readies To Mobilize In Favor Of Wasteful Medicare Spending

Being against rationing but in favor of cost-controls is a self contradictory position. Rationing is cost control and there is no type of cost control that isn’t a form of rationing. We have to be honest about this and make a call for rationing.

We’re actually purchasing shockingly little in the way of improved health for all that money

Americans are getting richer, agriculture is becoming more efficient, apparel is increasingly made by Bangladeshis or robots, etc. At the same time, computers and other electronic gadgets are getting cheaper in real terms. And if some things shrink as a share of our income, other things need to grow. The biggest of those things has been health care. And that makes perfect sense. Richer people should be spending our money trying to be healthier. The problem we have isn’t so much that the volume of health related spending is “too high” as it is that we’re actually purchasing shockingly little in the way of improved health for all that money.

From Something’s Got to Go Up

Looking at the numbers, it makes sense that where our money goes should shift as markets mature.

Thomas Jefferson and Government Run Health Care

Greg Sargent, today reports that it wasn’t only John Adams who supported the notion of government run health care. According to Georgetown University history professor and noted historian of America’s early days, Adam Rothman, Thomas Jefferson –the iconic hero of the Tea Party – also supported the legislation. Sargent reprints the following email he received from Prof. Rothan on the subject –

Alexander Hamilton supported the establishment of Marine Hospitals in a 1792 Report, and it was a Federalist congress that passed the law in 1798. But Jefferson (Hamilton’s strict constructionist nemesis) also supported federal marine hospitals, and along with his own Treasury Secretary, Albert Gallatin, took steps to improve them during his presidency. So I guess you could say it had bipartisan support.

Ezra Klein adds to the debate pointing out that:

…it was a payroll tax that all sailors on private merchant ships had to pay, and in return, they were basically given access to a small public health-care system. But it was, in essence, a regulation against a form of inactivity: You were not allowed to not do something, in this case, pay for sailor’s health insurance.

From Thomas Jefferson Believed the Federal Government Could Regulate “Inactivity” – Grasping Reality with Eight Tentacles

I don’t think this proves Jefferson would have approved of Obamacare. It does prove the futility tinged with intellectuality dishonesty that the Tea Party folks demonstrate when they claim to speak for the founders. From beyond the grave no less.

Malpractice Methodology

The traditional way to reform medical malpractice law has been to impose caps on liability — for example, by limiting punitive damages to something like $500,000. A far better strategy would be to provide safe harbor for doctors who follow evidence-based guidelines. Anyone who could demonstrate that he has followed the recommended course for treating a specific illness or condition could not be held liable.

From Malpractice Methodology – NYTimes.com

Great idea.

Reforming Medicare’s Payment System

Three-dimensional radiation costs roughly $10,000. A somewhat newer treatment, I.M.R.T., initially cost $42,000. And an even more recent treatment, proton radiation therapy, costs $50,000. The newer treatments do not seem to be more effective at keeping patients alive than three-dimensional radiation, so under the proposal all three treatments would be reimbursed (after the three-year trial period for the new ones) at $10,000.

Despite some of its downsides, this is a good idea — and precisely the type of shift in our reimbursement system than needs to happen if we are to reduce cost growth over time.

From Reforming Medicare’s Payment System – NYTimes.com

Orszag’s plan makes sense but the health care industry is going to fight anything that will reduce the use of expensive therapy and medications.

Will You Go To Jail If You Don’t Buy Health Insurance?

Will You Go To Jail If You Don’t Buy Health Insurance? No.

Section 501 of the House bill imposes a tax of 2.5 percent of adjusted gross income. You are exempted from the tax if you already have qualifying health insurance from your employer, if you receive benefits from Medicare or Medicaid, if you are a dependent, if you are overseas, and if you have religions objections. You also get subsidies in the form of tax credits and tax deductions if your income is below a certain level; and if you are in poverty you are already exempted because you participate in Medicaid. If you are not exempted, and you don’t purchase health insurance, you just pay a higher tax. You don’t go to jail.

From Will You Go To Jail If You Don’t Buy Health Insurance? – The Daily Dish | By Andrew Sullivan

This should not be shocking considering the pattern of hyperbole from the defenders of the status quo.

Healthcare Reform

There’s nothing “sure or quick” about changing medical liability laws that will improve healthcare or its costs. Defensive medicine adds very little to healthcare’s price tag, and rising malpractice premiums have had very little impact on access to care.

From Healthcare Reform – Salon.com

Of course it won’t. And it hasn’t. So far, there have been a number of states that have passed this kind of reform. Notice how you never hear about how much money these reforms have saved consumers in Texas? Because it hasn’t. It has made money for Blue Cross. You don’t hear about that either.

Our socialist post office

With all the talk about a government take over of health care turning it into the post office, I started to wonder what it would be like if the socialist post office was like private health care companies?

Each post office branch would use a totally different zip code system. They would charge different amounts to deliver to certain zip codes and refuse delivery to some zip codes. They would also make this information nearly impossible for people to look up. It would also change every six months.

In each zip code there would be independent letter handlers that would have agreements with some post office branches but not all. They would also make the bulk of their money via letter handling fees that would change depending on what branch the letter originated and the path they took to your home.

Two weeks after a letter was mailed, you’d get a bill telling you how much you owe to the post office, the letter carrier, the stamp processor and how much of that bill will be paid by your mail insurance. They would also send numerous things that look like bills but aren’t.

The post office would make more money refusing to deliver your mail than carrying it. Every year they would refuse more mail and deliver to a smaller section of people. The post master general would receive a larger bonus because of it.

A large section of the population would have no mail service. Any attempt to provide them with access to a public mail service or subsidized private mail service would be dismissed as socialism.

Elderly and retired people would have excellent, low cost access to the private mail system managed by the government. Any attempt to provide everyone with that same access will be viewed as an attempt to kill old people.

Anyone who points out that most other industrial nations have systems where everyone has postal service at a much lower cost will be compared to Hitler. After all, Hitler had his face on stamps.