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Home Publications Blogs Beat the Press Another Effort to Impose Philosophy on the Health Care Debate

Another Effort to Impose Philosophy on the Health Care Debate

Sunday, 01 July 2012 07:42

There should be an automatic fine of $10,000 for anyone who claims that a dispute between politicians is about philosophy. It should double the second time they say it and go up to $100,000 the third time.

Come on folks, this political science 101. The people that we see in Congress, the White House and elsewhere on the political stage did not get there because of their great philosophical works. They got there by appealing to powerful interest groups. And they stay there by appealing to powerful interest groups. So why are people in the media continually telling us about philosophy.

Glenn Kessler is the most recent sinner in his otherwise fine Fact Check piece on Sarah Palin's effort to bring back her "death panels" claims about ACA. Kessler notes that Palin now claims that her reference to death panels is the Medicare Independent Payments Advisory Board (IPAB), which she argues will be making life and death decisions about what payments to provide for various treatments.

Kessler comments that IPAB is an effort to contain the rate of cost growth within Medicare which is says is not very different from the system proposed by Republicans. The latter would provide beneficiaries with a voucher (which they like to call "premium support") whose growth would be restricted to a pace well below the rate of medical cost inflation.

Kessler then tells us:

"the dispute really centers on a philosophical divide between the parties. Democrats would rely on independent experts ...  Republicans would rely on the insurance marketplace to control costs."

What makes this is a question of philosophy? Let's be more concrete. The system put in place under the ACA would put the government in a position where it could squeeze money out of providers. It could specify prices for services and procedures and tell providers take it or leave it. Given the enormous and rapidly growing size of the Medicare market, most would likely take it.

By contrast, the Republican approach surrenders this market power. In fact, it increases by costs by relying on a network of private insurers that we know is less efficient than Medicare. (The Congressional Budget Office and other independent experts have documented this fact numerous times. Like global warming, it is no longer a debatable point.)

Kessler and the Post don't know anything about Republican's philosophical beliefs. They do know that they have proposed a Medicare plan that is likely to leave a higher share of Medicare dollars in the hands of insurers and give providers more money for each dollar of services. The paper should just stick with the facts and leave speculation about philosophy to readers.

Comments (6)Add Comment
written by Carl Weetabix, July 01, 2012 9:49
As Sarah must know given having a special needs child and the insurance fun that goes with it, private insurance sure as hell has its own "death panels". Private insurance regularly denies treatments it deams unworthy.

It truly is a vacuous argument - private insurance makes life and death "payment" calls all the time. In either case, if "personal responsibility" is your schtick - you can always pay out of pocket.
written by denim, July 02, 2012 2:43
So it is ok to have a "free market" in Apple type products, but the political elites just gotta regulate the hell out of the health care sector. It is ok to let consumer demand determine the supply of electronic gadgets and the resultant supporting jobs, but health care? Nope, gotta regulate that. How does one spell hypocrites? How does one spell free enterprise?
written by kharris, July 02, 2012 7:38

Your comment suggests a lack of understanding of the basics of the health care debate. The basics have been reviewed probably thousands of times during Obama's term, and there were a smaller number of such reviews prior to his term. If you are unaware of the basics, then I have to wonder why you feel qualified to comment. If you are aware of the basics, but choose to ignore them, I wonder why anyone should pay attention to you.

In addition, if you are a regular reader here, you are undoubtedly familiar with Dean's demonstration that the "free" market is anything but free. "Apple type" products are produced and sold in a regulated market. The regulations are far different from the ones in the medical insurance market, but the goods market is highly regulated.

There is an alternative for you. You could actually address the issues of market structure, distortion, adverse selection and the like, and try to show why a purely unregulated outcome would be superior. Or more realistically (?) you could try to show why regulating medical insurance in the same way we regulate the market for "Apple type" products would produce a superior outcome.
denim half right...
written by pete, July 02, 2012 10:27
As kharris points out (more or less), pretty much every attempt at regulation has been met by an equal and opposite regulatory capture (see Nobelist Buchanan). Sometimes the regulations themselves spring from deres to monopolize for either labor or industry. Health care provision is no different that a lot of other regulated industries in that sense...This is sometimes called the law of unintended consequences, or more directly a result of Potomac fever. Somebody has some good idea, proposes a regulation, industry or labor or both co-opts the idea, raises fixed costs so that small businesses are squeezed out...over and over...

Witness that ACA doubled down on the drug industry's capture.

Interesting that the reverse psychology got the Dem's to pass the Rep's Heritage Foundation health care. And that Roberts approved it.

No way will these national panels will control costs...look at expected medicare/medicaid expenses over time...govt. spending always costs more than expected.

Remember the outcry when then well intentioned HMOs started using rational health care decisions. Same thing will happen here. "Patient Rights Act of 2013" on the horizon?
Larger Fine
written by Donald Pretari, July 02, 2012 3:21
I agree, the Fines should be much more punitive.
written by Donald Pretari, July 02, 2012 3:28
...but the Fines...

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About Beat the Press

Dean Baker is co-director of the Center for Economic and Policy Research in Washington, D.C. He is the author of several books, his latest being The End of Loser Liberalism: Making Markets Progressive. Read more about Dean.