To Dream The (Im)Possible Health Care Reform Dream

By mw | Related entries in Congress, Fiscal Responsibility, Health Care, Ideas

Donk Quixote and Phanto

This is a joint post of Justin Gardner (Donk Quixote) and Mike Wallach (Phanto), wherein they endeavor to tilt at windmills (with many apologies to Miguel de Cervantes):

“And no sooner did Donk Quixote see them that he said to his squire, “Fortune is guiding our affairs better than we ourselves could have wished. Do you see over yonder, friend Phanto, the hulking healthcare insurance giants? I intend to do battle with them and slay them. With their spoils we shall begin to have healthcare for all, for this is a righteous war and the removal of so foul a brood from off the face of the earth is a service God will bless.”

“What giants?” asked Phanto.

“Those you see over there,” replied the blogmaster. “With their long corporate arms. Some of them have arms well nigh two leagues in length.”

“Take care, sir,” cried Phanto. “Those over there are not giants but bureaucrats and political windbags. Those things that seem to be their arms are purses which, when they are filled with contributions, weigh heavily on the laws that control our lives.”

Those familiar with Justin and Mike from reading this blog, know that we are generally at odds, disagreeing more than we agree. Justin is a registered Democrat, and considers himself a liberal with independent leanings. Mike most recently registered as a Republican, but considers himself primarily a fiscal conservative, deficit hawk, and a libertarian leaning independent.

But lo and behold: We found common ground in the Health Care Reform debate.

If we were starting with a blank slate, we would support vastly different and incompatible health care systems. But we are not starting there. We have different objections to the existing system, but agree that the current system is in need of reform. We also agree that the reform most Americans want includes three critical criteria:

  1. Universal coverage for all Americans
  2. Insurance against financial ruin if struck with an illness.
  3. The reform program be fiscally responsible, manageable and have understandable costs.

What currently existing bill hits all three?

Wyden-Bennett.

Yes, we both support (S-391) The Healthy Americans Act and agree it represents a good foundation on which to build rational Health Care reform.

Donk Quixote (JG):

“Wyden-Bennett has my support because it does away with the pre-existing condition clause, reigns in costs and has the potential to cover more Americans than the current legislation being proposed.”

Phanto (mw):

“Wyden-Bennett has my support because it meets the critical criteria for reform, does it better than HR 3200 and does it without increasing the deficit or requiring net new taxes. Wyden-Bennett has my support because it directly and honestly attacks the central problem of employer based health care insurance as the primary delivery vehicle for non-public health care in America. Wyden-Bennett has my support because it is not (yet) saddled with questionable deals for big pharma, big insurance, and payoffs for big union contributors.”

Saying we support Wyden-Bennett does not mean we have no reservations about this bill. Au contraire mon frère…

Donk Quixote:

“Wyden-Bennett feels like it’s the co-op idea only it takes EVERYBODY’s health coverage away who currently has it through their employer and makes them buy it again. Basically, no more tax breaks for health care. I’m in favor of the principle of that, especially if it could cut costs, but I do think that the radical restructuring of the system would be opposed by many more Americans because it’ll be seen as taking something away from them and would require a lot more work on their part. How do you think a plan that starts off with “First, you lose your insurance…” would play with Americans? Because you know that’s how it would be positioned. This could be a non-starter for many. And to that point, do you really think members of the right wing who kept on saying “Obama is going to raise your taxes!” would stay quiet and accept Wyden-Bennett?

Also, getting back to the co-op idea…does anybody really think creating a system that would dump EVERYBODY off of their insurance is more politically palatable than one that simply opens up options and provides subsidies for those w/o health insurance or those working for small businesses? Bipartisan or not, this bill represents a VERY radical reshaping of how we buy and sell health insurance in this country and such a seismic shift doesn’t seem politically feasible to me.

Phanto:

“I describe myself as a “libertarian-leaning independent”. There are elements of Wyden-Bennett that cannot be reconciled or rationalized with anything that resembles libertarian principles. This is where I have my greatest heartburn with this bill. Chief among them, this bill has mandated coverage. The bill does not work financially without mandated coverage. It works very well with it. It could be rationalized that individuals will have a much wider range of choices under Wyden-Bennett. But I won’t call that a libertarian argument, because individuals will not have the option to not participate.

The trade-off for this mandated coverage is that we get a fiscally sound health care system that covers everyone, that puts no one at risk of financial ruin from getting sick, and does it without raising the deficit or requiring net new taxes. I am willing to take that trade-off. This is why I describe myself as libertarian-leaning as opposed to libertarian or Libertarian. Once in a while, I feel compelled to lean another way.”

Are the politics of Wyden-Bennett within the “art of the possible”?
No idea. It feels like it should be. Universal coverage for all, catastrophic illness protection for all, no increase in the deficit and no net new taxes. What’s not to like?

Clearly there is a constituency on the left who will find nothing less than a Single Payer system to be acceptable. They will never accept this bill and are excluded from the pool of potential supporters. Clearly there is a constituency on the right who will find nothing less than a market based system with little or no government participation to be acceptable. They will never accept this bill and are excluded from the pool of potential supporters. But for the rest, for the wide range of liberals, conservatives and independents who would like to find some common ground and believe there is a need to reform our healthcare system – this presentation is for you:


(There is a four slide “Keep It Simple Stupid” version linked here and embedded at “Divided We Stand United We Fall”.)

Does Wyden-Bennett actually have bipartisan support?
Commenter Mike (not mw) kicked off an interesting discussion among the Donklephant commentariat, questioning whether there is sincere bipartisan support for this bill, or whether Republicans were simply using it for political cover. There is one way to find out. Get behind it, and if there is enough popular support, we will see what happens. Our guess, the compelling fiscal calculus – true reform with no net new taxes and no increase in the deficit – permits the inner fiscal conservative of many Republicans (and Blue Dog Dems) to overcome their other concerns.

Outside the halls of Congress, bipartisan support in the new and traditional media is visible, broad and deep:

  • “[Wyden-Bennett] is probably a better approach than the consensus Democratic plan, which doesn’t have hard cost controls at all, and so doesn’t really explain how it’ll save enough money to be sustainable over the long haul.”
    - Ezra Klein
  • “Now you might think that in these circumstances someone might take a second look at the ideas incorporated in the Wyden-Bennett plan, which already has a good C.B.O. score, bipartisan support and a recipe for fundamental reform”
    - David Brooks
  • “The Senate’s smartest health-care wonk, Ron Wyden of Oregon, believes we should move away from job-based insurance. He has introduced a bill that would do this by converting the tax deduction for employer-provided health insurance into a tax credit and requiring individuals to use it to buy insurance. This would achieve universal coverage, apply meaningful cost controls, and—according to the Congressional Budget Office—pay for itself within a few years.”
    - Jacob Weisberg
  • “The Wyden-Bennett bill is less expensive, covers just as many people and has actual bipartisan support. So far nine Democrats and five Republicans are sponsors, while no Republicans have backed the president’s plan yet.
    - Salt Lake Tribune
  • “Despite being the darling of health policy bloggers and the first bill to be certified by the Congressional Budget Office as covering nearly everyone and fully paying for itself, the measure is being roundly ignored by those actually trying to put together a health overhaul measure on Capitol Hill and in the White House.”
    - NPR
  • “A divorce of health care benefits from employment would increase social mobility, provide more individual investment in our health, and the reforms present in the Wyden-Bennett proposal would also ensure that people, regardless of pre-existing conditions or age, could still attain health benefits.”
    - E.D. Kain
  • “Under the Wyden-Bennett system, health dollars would be controlled by the individual (a long-time conservative goal) and used within a restructured, heavily regulated, totally universal, insurance marketplace (a longtime liberal goal). Each state would create Health Help Agencies, who would provide easy access to insurance products, along with information, guidance, and advice on how to choose. Insurers would have to meet a minimum standard for comprehensiveness (equivalent to the standard Blue Cross/Blue Shield plan currently offered to members of Congress), and they could not discriminate based on pre-existing conditions, occupation, genetic information, gender or age. Nor could they deny insurance to those who ask for it. In return, every American would have to buy health insurance, and there would be hefty subsidies for those further down the income ladder.”
    - American Prospect
  • “The idea has a lot of appeal. It would give most people far greater choice than they have now, and they could take their benefits with them when they change jobs. It also provides generous subsidies for those who cannot afford to purchase health care on their own, and yet the Congressional Budget Office has said the proposal would be “revenue neutral,” which means it wouldn’t add to the deficit. It would include a minimum defined-benefits package, with no exclusions for pre-existing conditions.”
    - TIME

UPDATE: Simon complains in the comments that the right is underrepresented in this sampling. We strive to please and are adding two more quotes:

  • “The plans favored by Massachusetts Sen. Ted Kennedy or President Barack Obama rely on a “public option” in which government insurance would supposedly “compete” with private insurers, a move many see as leading to a single-payer system. By contrast, the Wyden-Bennett Healthy Americans Act relies on the private insurance market while imposing a series of regulations to squeeze savings from the private sector… The idea, Mr. Wyden says, is to harness the Democratic desire to get everyone covered to the Republican interest in markets and consumer choice. “Everything I’ve been up to with this coalition is designed to make reconciliation irrelevant,” he explains, referring to a political maneuver whereby Democrats might try to force through health reform on a bare majority of 51 votes rather than the filibuster-proof 60 votes normally required. ‘People can’t be tricked into fixing health care.”
    - WSJ
  • “Republicans should embrace universal healthcare by supporting the Wyden-Bennett Healthy Americans Act. There is no another viable way to get rid of the tax-free treatment of employer-provided healthcare benefits that is severely distorting the healthcare market. Once you throw in on top of that greater benefits than those currently offered for families and individuals, consumer choice among competing healthcare plans, portability of health insurance, and (adding in the inevitable under-estimate of total cost) a price tag that costs a trillion dollars less in the next decade than any Democratic plan, you end up with the best bill in either chamber.”
    - Tom Church

It should also be pointed out that, unsurprisingly, there is bi-partisan opposition to this bill. :END UPDATE

In the end, tilting at windmills can be an exercise in futility, but oddly, we still feel pretty good about it.

With that, Donk Quixote and Phanto ride into the sunset.

Cue “Man of La Mancha”

This is my quest, to follow that star …
No matter how hopeless, no matter how far …
To fight for the right, without question or pause …
To be willing to march into Hell, for a Heavenly cause …

And I know if I’ll only be true, to this glorious quest,
That my heart will lie peaceful and calm,
when I’m laid to my rest …
And the world will be better for this:
That one man, scorned and covered with scars,
Still strove, with his last ounce of courage,
To reach … the unreachable star …


This entry was posted on Thursday, August 27th, 2009 and is filed under Congress, Fiscal Responsibility, Health Care, Ideas. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

35 Responses to “To Dream The (Im)Possible Health Care Reform Dream”

  1. Chris Says:

    “…no increase in the deficit and no net new taxes. What’s not to like?”

    I haven’t read the details of the bill itself besides what has been discussed, but I am deeply opposed to taxing health care benefits. That is because my healthcare benefits come out to about 25k a year. So unless I get a 10k raise, there’s no way I could pay for the taxes on my benefits. I would much rather have universal coverage/one payer type system that would strip the need to have employer based coverage than being taxed on current benefits.

  2. Nick Benjamin Says:

    It would be great if we could actually get it passed.

    The difficulty is that all the groups Obama spent the first six months of the year appeasing hate the idea. Real cost controls means hospitals have to cut costs, insurers have to cut their pay (aka: “administrative costs”), drug companies can’t just name a price, advertisers can’t count on drug company money, etc.

    The unions will never get on board with this because it’s funded by taxing health plans as income. Norquist types hate taxes, so they ain’t getting on board either.

    Add in the fact this would actually take health care away from most Aeericans, and then give them a new plan; which scares the crap out of them; and you’ve got a recipe for a debate at least as nasty as the current one.

    Personally I think the chances of medicare for all, or nearly all, are more likely. The Dems could force that through under reconciliation if they can’t get Obamacare through.

  3. mw Says:

    @Chris
    As I said in the post, there are certainly those who feel that a “single-payer” system is the only reform they would support. My guess is that, given the breadth of opposition to Obamacare with a public “option”, there simply is not enough support in Congress or the country for that plan. As I said – just my guess.

    To your other point on the affordability of Wyden-Bennett, this from a Lewin Group report [PDF]on the plan:

    “The Kaiser Family Foundation (KFF) reports that nearly 20 percent of nonelderly Americans paid more than ten percent of family income for health insurance premiums and co-payments for health services (e.g., deductibles and co-insurance).1 The HAA on average reduces family
    out-of-pocket spending for health care among currently insured Americans with incomes below $150,000 (Figure 1).2 In fact, families with incomes below $150,000 per year would on average see a net reduction in spending.

    The HAA achieves these savings through a combination of improved benefits, new income related premium subsidies, a new standard income tax deduction for health care and broadened access to cost saving coverage alternatives.3 The plan reduces out-of-pocket spending for health services by guaranteeing that all families have access to coverage that is at least as comprehensive as the plans offered to federal workers and members of Congress. In fact, we estimate that the standard coverage option offered to members of Congress would represent an improvement in coverage for about 60 percent of workers who now have employer coverage.4 The Act also provides an income-related premium subsidy for people living below 400 percent of the federal poverty level (FPL) (about $80,000 for a family of four). The plan would pay 100
    percent of the premium for people living below the FPL. The percentage of the premium paid by the family increases to 100 percent on a sliding scale with income for people with incomes between the FPL and 400 percent of the FPL. These subsidies are designed to assure the affordability of coverage for both the poor and those with moderate income levels.”

  4. mw Says:

    @nick
    Hence the allegory. However, if you think passing single payer (medicare for all), is any less of an exercise in windmill tilting, I am afraid you are as delusional as Donk Quixote and me.

  5. Nick Benjamin Says:

    Single payer has a large base already, so I’d say it’s slightly more likely to pass than Wyden-Bennett. That only has wonks.

    If the Obama plan fizzles there will at the minimum be a major expansion of Medicare. All over-55 will get it. A larger expansion makes more political sense — turnout in 2010 is likely to be in the mid-30s, so energizing the single-payer folks will be smart politics. And they’d definitly turnout if Obama got single-payer for over-45s.

  6. Simon Says:

    If “bipartisan support in the new and traditional media is visible, broad and deep,” why is it that all the sources cited in support of that statement (with the lone exception of David Brooks, nominally a Republican) are on the left? Wouldn’t the statement be better-supported by demonstrating bipartisan support, if it is truly so visible, broad, and deep?

  7. mw Says:

    @simon
    E.D. Kain is a right-of-center blogger, and I don’t think the Salt Lake Tribune is considered left (although I don’t read it that often, so could be mistaken). Also Mark Thompson from the same group blog (Ordinary Gentlemen) self-identifies as libertarian and supports the bill. But, it’s a fair criticism. I’ll dig up a couple more links and update the post.

  8. Simon Says:

    My bottom line, for the record, is that most of the plans being floated are too new and thus, necessarily, too little thought out. (There are some with deeper roots, to be sure, but they are crazy, and thus out.) Compare ERISA. It was enacted only after Congress spent almost a decade studying the matter addressed by the bill, see Nachman Corp. v. PBGC, 466 U.S. 359, 361 (1980), and its “comprehensive and reticulated” framework has still engendered decades of dizzyingly complex litigation. How sensible, then, to overhaul the even more complex healthcare system—or, at very least, to inject a huge and unpredictable element into the mix—after so little contemplation, with plans thought up (relatively-speaking) overnight?

    What we ought to do is follow Justice Brandeis’ suggestion: let the states experiment, serving as laboratories, and see what works. Does a system patterned after Romneycare work? A good way to find out is to see if Romneycare works, and the jury’s still out. If it doesn’t, is the reason it didn’t work a cat that would not knaw the ankles of a similar program enacted on a federal level? Or is it something that can be fixed? Passing underthought, underconsidered, premature legislation will not only bypass such state activities, but, since it is almost certain to have a broad preemptive effect, will also extinguish them.

    Wikipedia has a good maxim: “Wikipedia is not for things made up in a day.” The same should go for reforming a critically important and exceptionally large sector of the economy. This debate has been prosecuted by the left as if it were a dire emergency requiring immediate action, and (sub rosa) as if there were no costs associated with failure. A hothouse atmosphere is not conducive to calm deliberation. So it isn’t helpful. Nor is it necessary or even appropriate: The world will not end if this Congress does not pass healthcare reform. The bill will not be any more imperfect if it is not titled “The Senator Edward M. Kennedy __________ Act.” If it is to be done (and it is not clear that it should be), it is more important that we get it right not that it is done right now.

  9. mw Says:

    @Simon,
    I don’t disagree. I’d like to see Congress and the President take whatever time is needed to get it right.

    However, I do think that what David Mayhew calls a “public mood for change” on health care policy does exist in the country right now. His thesis is that this “mood” is a prerequisite and predictor for legislative productivity on a bill of this scope. To a large degree, the insurance companies have brought this on themselves. I don’t know anyone who has not heard a horror story about healthcare insurance. Despite representations I’ve read by some critics that most people are happy with current status, I don ‘t believe it to be true.

    If you accept that premise, then something is going to be passed and signed into law. Given that reality, I’d like it to be something that at least has some rational basis for addressing the change people are looking for (unlike HR 3200), and doing it without bankrupting the country. Wyden-Bennett looks like that foundation to me.

  10. Nick Benjamin Says:

    The problem I have with the wait argument is simple: we tried it.

    Clinton thought his plan through. It was beautifal. Very smart people adeptly analyzed what would happen. He didn’t get out of Committee. Decades eariler LBJ had an equally thoughtful plan. He based on Canada’s system, and even gave it the same name “Medicare.” It passed, but only because it did not apply to most of the country.

    America has Checks and Balances. This is a fancy way of saying it’s easy for small groups to kill new ideas. The system does not distinguish between good ideas and bad ideas.

    Today America has an extremely partisan Senate, and a Senate GOP that’s clearly decided that killing health care is in their best interest. Translation: Check.

    So we can take this half-assed plan, and try to ram it through despite the opposition. And in spite of the fact that it could clearly be a lot better. The alternative is clear: Lots of talk, and zero action, because there are 40 Republicans in the Senate.

  11. mw Says:

    You appear to be arithmetically challenged here Nick. 40 Republicans in the Senate means 60 Democrats in the Senate (or more precisely – 60 Senators in the Democratic caucus – and lets assume that Senator Kennedy’s replacement will be appointed). As such your blame for blocking your preferred health care bill is misplaced. Democrats are primarily to blame for blocking it.

  12. gerryf Says:

    sigh…

    Do you want to know why this plan is gaining some traction–because the private insurance companies will make tons of money off of it.

    Mandate that every single personb pay into the system then hand that money over to the insurance companies who are once again under no pressure to keep costs down.

    Anyone who thinks that the acts “government controls” are going to control costs haven’t been paying attention to the government controls over military spending.

    The current private insurance system is one part collusion and one part virtual monooly with only a few players–they set the price and we all pay for it. Yes, it would lower some per capita costs because now instead of 60 percent of the country paying a hypotentical hundred dollars each, we woudl have 100 percent of the country paying a hypothetical 80 dollars each….but in the end, the insurace companies get rich(er).

    If you want to lower costs and provide health care for all, create a public option which is supported by everyone except legislators and insurance companies and let the private insurers compete with it or see their revenue streams dry up.

    But we won’t see that because the GOP (which claims they want compettion, but really don’t) and the Dems (who lack the poltical will to do what they were sent to Washington to do) are both in the pocket of the insurance companies and healthcare providers.

    Compromise plans like Wyden-Bennett only have a change because big healthcare doesn’t completely object to a plan with some restraints provided they make even more money than they currently make

  13. Nick Benjamin Says:

    mw, you have an awful lof of faith in the efficiancy of MA’s politicians.

    According to the numbers in theory a long debate approach chould have worked with this year. But in reality it is virtually impossible to get an entire caucus on-board for anything big. Particularly after a long, divisive debate on health care in which a couple guys made major proposals that were shot down…

    But in practice the Dems haven’t had 60 votes for most of the year. They started with 58, Specter was 59, and Franken made 60.

    Even the ram-it-through approach has got one guy fighting his individual jihad for his pet plan (Conrad and co-ops).

  14. Simon Says:

    MW, Just a very quick response since I’m running late for Mass. You may well be right that a “‘public mood for change’ on health care policy does exist in the country right now,” but that merely calls to mind The Federalist, nos. 62-3: “The necessity of a senate is not less indicated by the propensity of all single and numerous assemblies to yield to the impulse of sudden and violent passions … [and] such an institution may be sometimes necessary as a defense to the people against their own temporary errors and delusions.”

  15. Chris Says:

    MW – I pay 70 a month for family coverage with no coinsurance and no copayments for anything except an e-room visit, which is $75. I have no yearly maximum coverage. My employer – the university – pays about 1400 bucks a month I believe. It’s somewhere close to that, i’d have to look up my statements from last year to be totally sure. Getting taxed on that would increase my taxes by 1/3.

  16. mw Says:

    Dammit Justin. This was a joint post. I think I am carrying more than my share. Where is your liberal sense of sacrifice and and fairplay? Okay…

    @Nick
    I am not questioning or underestimating the difficulty of maintaining partisan fidelity in the Senate, even with a 58-60 vote Democratic plurality. I am questioning your knee-jerk reaction of blaming Republicans for obstructing Democratic ambitions, which – given the numbers – is on the face of it absurd.

    @Simon
    I’d love the Senate to carefully and slowly deliberate this legislation. My point is that this freight train is barreling down the track fueled by that “public mood for change.” Fiscal conservatives have two choices – 1) Stand in front of it and yell “Stop!” -or- find a switch and throw this train on a track that won’t blow an additional $1-2 trillion dollar hole in the deficit. I’ve chosen my strategy.

    @Chris
    You are at a level of granularity that I am not, and cannot begin to answer what would happen to you specifically with this plan. My general understanding is that some or all of what your employer is paying for your health care insurance would transfer to you or put under your control, perhaps in the form of a raise, perhaps in the form of a voucher. You would then be able to select the same Employer plan or from a wide range of other plans – including a functional match to the plan our congress-critters get, or potentially a state controlled public plan. Depending on your income and tax status you may be eligible for subsidies or credits, or you may indeed be paying a tax on the plan you select. From what you describe, you’ve got what many in Congress are calling a “Cadillac Plan” that is far better than most Americans. so I suspect you are right and will wind up paying more than you are now if you choose the same plan, (unless you qualify for subsidies and credits). That’s the best I can do. The devil is in the details, as it is with all these schemes.

  17. Simon Says:

    Nick

    The problem I have with the wait argument is simple: we tried it.

    That is a disputable point, but to the extent it holds, it has worked out pretty well. We have a healthcare system that is the envy of the world. (No matter now much Europe may sneer, revealed preference says otherwise: those who can afford to do so invariably escape their own healthcare regimes, either “going private” at home or by coming here. Senator Kennedy, it should be noted, did not go to Canada to be treated.)

    The extent to which we have not tried it, by contrast, is the enactment of programs such as medicare, and how have they worked out? Well, they now represent a massive, all-but unreformable and demonstrably unsustainable chunk of mandatory government expenditures. It turns out that whether something is working depends a lot on what you use as the measure.

    It may be true that “Very smart people adeptly analyzed what would happen” if Clinton’s plan was enacted, but the ability of very smart people to predict the future, controlling for variables foreseen and unforeseen, is not great. Event studies can help, but only to an extent. Skepticism of human ability to predict how a comlpex system will be affected by a change that may itself be complex is conservative bedrock. And we see it reaffirmed every day in every case that identifies statutory ambiguity. I can think of no reason to suppose that those who drafted Hillarycare (and who are drafting Obamacare) have better foresight than those who drafted ERISA, and as I’ve mentioned above, the volume of litigation involving ambiguities that one might expect to have been plugged if the drafters noticed is substantial. Simply put, “unforeseen consequences” is an iron law.

    America has Checks and Balances. This is a fancy way of saying it’s easy for small groups to kill new ideas. The system does not distinguish between good ideas and bad ideas.

    I would omit the word “new” (there are few ideas that are new, and those that really are new are usually the most dangerous ones), but, mutatis mutandis, quite so. Likewise, Victor Hugo observed that “[n]othing is as powerful as an idea whose time has come” – a maxim that also does not distinguish between good ideas and bad ideas.

  18. Chris Says:

    MW, I don’t have a problem paying more money for everyone to have health care, what I do have a problem with is paying more money just so the insurance companies can still rape us.

  19. Nick Benjamin Says:

    That is a disputable point, but to the extent it holds, it has worked out pretty well. We have a healthcare system that is the envy of the world.

    You can claim that all you want. But there are two health systems nobody, in the entire world, barring true extremists, wants replicated in their countries: ours and the UK’s. Many people want to adopt individual elements of out system (typically the wide avaliabiloity of specialists), but replicating the whole thing? Nope.

    The Brits, for their part, are convinced their system is much better than ours. And in terms of dollars and cents it clearly is, because it’s ridiculously cheap but provides overall results conmparable to our own.

    (No matter now much Europe may sneer, revealed preference says otherwise: those who can afford to do so invariably escape their own healthcare regimes, either “going private” at home or by coming here. Senator Kennedy, it should be noted, did not go to Canada to be treated.)

    When people actually go abroad for treatment they go to Europe most of the time. Aging African dictators are notorious to flying for Paris for medical treatment because they know France has the best health care money can buy.

    BTW, in most of Western Europe everyone is in a private plan. Germany and France use lots of private non-profits to provide insurance. The Swiss use non-profit arms of for-profit companies. Single-payer proper is only used by Canada and the Scandinavian countries. And like I said nobody wants to import the UK’s NHS.

    The extent to which we have not tried it, by contrast, is the enactment of programs such as medicare, and how have they worked out? Well, they now represent a massive, all-but unreformable and demonstrably unsustainable chunk of mandatory government expenditures. It turns out that whether something is working depends a lot on what you use as the measure.

    The problem with Medicare expenditures is that they’re in America’s health sector. As such they start out extremely high, and are growing at a ridiculous rate. The same thjing happens to every private policy, but companies can just dump good (expensive) ones for worse (cheaper) ones when they need to balance the books.

    Other countries have the problem, but it’s not as severe as ours, which implies that our wait and see approach is not working.

  20. Divided We Stand United We Fall Says:

    A K.I.S.S. for Wyden-Bennett ObamaCare Sales 101 – Lesson #4 …

    Of course, it was impossible for me to leave well enough alone, so there is also a somewhat more complicated 12 slide presentation linked here, and embedded in a somewhat more allegorical post at Donklephant. Yes, we are tilting at windmills… …

  21. Simon Says:

    Nick, stripped of its pretense, your reply is that the rest of the world wants the quality of our healthcare system, they just don’t want to pay for it. Well, as Marian Call says, I want a smaller waist, but I want doughnuts, too. If you adopt the structure of European healthcare, you adopt its deficiencies, too. Or did you think that it was sheer coincidence that America leads the world in quality of care? It’s a package deal, and ours is better.

    I must also add, on a personal note, that unlike most Americans, I have been in the care of Her Majesty’s National Health Service. For example, I’ve had dental surgery in Britain, and I’ve had dental surgery in America, and all I can say is (to paraphrase Bob Reich) that statistics don’t always reveal the most telling realities. Actually experiencing the two systems reveals a reality that statistics don’t always capture. Qualitatively, American healthcare is not merely superior, it is in another league superior.

    The misleading nature of statistics means that when I see people suggesting that America move toward a European system, I’m reminded of the days where the Soviet Union would claim the superior efficiency of its economy based on statistics of outputs with absolutely zero economic utility. They would claim that their economy produced more steel, for example, and they could prove it! But the statistics failed to take account of the quality of the steel, or the actual demand for it. It wasn’t that the statistics were wrong, it was that they missed the point. Busy != productive. Similarly, you can cite statistics that make the American healthcare system look problematic, but if you’re producing oodles of steel that just sits and rusts on a pallet in Siberia, or healthcare a mile wide and an inch deep, that isn’t progress.

  22. Jim S Says:

    Simon says…”Nick, stripped of its pretense, your reply is that the rest of the world wants the quality of our healthcare system, they just don’t want to pay for it.”.

    Nick said no such thing. Your post on this is amazingly fact free.

  23. mw Says:

    I think I am channeling Charles Krauthammer. Or he is a Donklephant reader. Or something. Check out this quote from his WaPo column today:

    “…selling pain is poor salesmanship. Promise nothing but pleasure — for now. Make health insurance universal and permanently protected. Tear up the existing bills and write a clean one — Obamacare 2.0 — promulgating draconian health-insurance regulation that prohibits (a) denying coverage for preexisting conditions, (b) dropping coverage if the client gets sick and (c) capping insurance company reimbursement. What’s not to like? If you have insurance, you’ll never lose it. Nor will your children ever be denied coverage for preexisting conditions.

    So – he invokes the poor Obama salesmanship theme as in the post linked here, the recommendation to move from ObamaCare 1.0 to ObamaCare 2.0 as in the embedded slide presentation above, and then there is a striking similarity to this quote from this post:

    “Universal coverage for all, catastrophic illness protection for all, no increase in the deficit and no net new taxes. What’s not to like?”

    .
    Weird.

    As to content – He does not specifically mention Wyden Bennett, but he sure seems to be describing it. Of course, he comes to a very different conclusion, implying that even this would be a trojan horse for single payer. As we said in the post, some on the right, like some on the left, will oppose this act regardless of merit. The question is whether there is enough of a coalition to support it.

  24. Nick Benjamin Says:

    Nick, stripped of its pretense, your reply is that the rest of the world wants the quality of our healthcare system, they just don’t want to pay for it.

    Really?

    I thought my reply said the opposite. The rest of the world gets our quality of care while paying less.

    Take France. It’s cheaper by every measure, provides better overall outcomes by every measure, has lower wait times than us, and costs them a lot less. Remember the French aren’t exactly cheap to care for. They love smoking and drinking. They don’t do Cooking Light. They think “heavy legs” are legitimate medical ailment:
    http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/7779126.stm

    BTW the last link shows you precisely why nobody wants to recreate the British system, despite it’s wonderful numbers:

    “Oh for goodness sake,” the nurse said brusquely. “Anyone would think you were dying. You’ve only got suspected leprosy.”

    Well, as Marian Call says, I want a smaller waist, but I want doughnuts, too. If you adopt the structure of European healthcare, you adopt its deficiencies, too. Or did you think that it was sheer coincidence that America leads the world in quality of care? It’s a package deal, and ours is better.

    You got a number that proves that our overall package is better? This is overall package we’re talking about, so stats on cancer treatment are only a tiny part of the picture.

    And it only counts if you haven’t cooked it by ignoring major causes of death in the US.

  25. Simon Says:

    Nick Benjamin Says:
    August 28th, 2009 at 1:53 pm

    Nick, stripped of its pretense, your reply is that the rest of the world wants the quality of our healthcare system, they just don’t want to pay for it.

    Really?

    I thought my reply said the opposite. The rest of the world gets our quality of care while paying less.

    No, they don’t. It’s not clear that they pay “less,” all in (free at point of access is not the same thing as free, the cost is simply diffused across more payers across longer tranches of time), and it is absolutely clear that they do not get our quality of care. Again, those who can choose choose American healthcare, and revealed preference is a far better indicator than rhetoric. I truly doubt that any American would choose to seek care abroad, given the choice, and your own observation that private care to augment government-run systems is widespread demonstrates the perceived inadequacy of the latter. As Margaret Thatcher said twenty years ago, asked why she had private insurance rather than relying on the NHS, she wanted to be able “to go into hospital on the day I want; at the time I want, and with a doctor I want.” Why so many Americans are hell-bent on diving into a hole whence so many are trying to escape is truly puzzling.

  26. Nick Benjamin Says:

    No, they don’t. It’s not clear that they pay “less,” all in (free at point of access is not the same thing as free, the cost is simply diffused across more payers across longer tranches of time),

    Uhh…

    According to official budget figures all European governments spend less, per capita, than we do. Right now I’m just talking federal expenditures. Federal expenditures on the VA, Medicare, Disability, insurance for federal employees, Medicaid, etc. adds up to more per capita than any European country, or Canada.

    So you’re implying that, in several advanced Democracies, a) the government is lying about it’s health expenditures for no reason, and b) non-Federal health spending in the US is trivial.

    Good luck with that one.

    and it is absolutely clear that they do not get our quality of care. Again, those who can choose choose American healthcare, and revealed preference is a far better indicator than rhetoric.

    Dude, there is no mass movement of French people demanding American Doctors. My Swedish cousins inquired about getting into US Universities, but have never asked about US health care. And one of them needed multiple liver transplants.

    You’ve read horror stories from Canada and the UK, and applied them to the European mainland. It simply does not work.

    I truly doubt that any American would choose to seek care abroad, given the choice, and your own observation that private care to augment government-run systems is widespread demonstrates the perceived inadequacy of the latter.

    For one thing Cuba has quite a few hospitals catering to Westerners. As a Detroiter I know several people who could use either the US health system or the Canadian, and most of them choose the Canadian.

    For another if you actually read my post you’d know that the French private system is the only system. It’s universal because they pay all premiums for the basic package through tax revenue, not because some pinhead in the Health Ministry approves every heart transplant.

  27. Jim S Says:

    Anyone who refers to “European health care” as though it is some kind of monolithic system is only betraying the fact that they neither know anything about it or have tried to remedy the situation with research.

  28. michael reynolds Says:

    Simon:

    Actually I have actively considered using European or other foreign health care should the need arise.

    I’m in the individual market — and shut out by virtue of being over 50. I have no pre-existing conditions of any seriousness, but I cannot get health insurance. I have a temporary policy that expires in a month. I have now formed a corporation so that I can create a group plan for myself and my wife (and potential employees.) So we may be able to remedy the situation. But we may not.

    But if I learned that one of us had a condition that could be dealt with elsewhere you bet I’d consider it. The American choice often comes down to bankruptcy or death. I hope I don’t sound too unpatriotic if I say I don’t much like that choice.

    You don’t know what you’re talking about on this. Homeless shelters are full of families who had the bad taste to get sick.

    Before it comes to that you bet I’ll hop a plane to France or for that matter India or Mexico where I can get the same treatments — up to and including organ transplants — for a quarter of the price.

  29. michael reynolds Says:

    I want to add that I am hardly alone in considering overseas medical treatment for some future need. There’s a whole, thriving industry of “medical tourism.”

    You can get a kidney transplant, fly first class and stay in the nearest Ritz-Carlton for a fraction of what it costs in this, the best of all possible systems.

    Setting aside specific procedures, if I could trade our system for the French system I would do it in a flash. So would any American who looked at the facts.

  30. The BoBo Carnival of Politics - August 30, 2009 Edition | The BoBo Files Says:

    [...] presents To Dream The (Im)Possible Health Care Reform Dream posted at Donklephant, saying, “Do the politics of the Wyden-Bennett Healthy Americans Act [...]

  31. The League of Ordinary Gentlemen Says:

    scattered thoughts on health care…

    It is equally disheartening to see the Club for Growth go after Sen. Bennett and by extension, the Wyden-Bennett bill, which is the best piece of health care reform legislation out there. It would be so nice to stop playing this game for awhile….

  32. Justin Gardner - Political Pulse – Unlikely Republican Signals Openness For Health Care Compromise - True/Slant Says:

    [...] Well, at least one unlikely Republican health care reform advocate is already floating his trial balloon and it sounds a lot like the Wyden-Bennett bill that I talked about recently. [...]

  33. Kostub Deshmukh Says:

    Wyden-Bennett still relies heavily on insurance as the primary controller of health-care spending. That is not going to reduce costs – we need to look at approaches for eliminating health insurance from the picture and restricting it to catastrophic insurance:

    See my proposal on the reform:
    http://hoothoothoot.wordpress.com/2009/09/15/health-care-reform/

  34. Donklephant » Blog Archive » Requiem For A Health Care Reform Dream Says:

    […] August, Justin and I cooperated in crafting a joint post in Quixotic support of S 391 -the “Wyden-Bennett” Healthy Americans Act. That bill has […]

  35. Donklephant » Blog Archive » Oboomercare and The Generational Sting Says:

    […] views of the original health care reform debate were well documented on this blog including posts here, here, here and here. More interesting to me now is the financial impact of Obamacare across the […]

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