Saturday, November 10, 2007

Friday, November 09, 2007

A Moment of Honesty From Krugman!

The ineffable Paul Krugman today (NY Times) critiques the arguments against single-payer "reform" of the U.S. health-care system, by summarizing those arguments as such caricatures that his discussion itself truly is a caricature of itself. How does he summarize the arguments against single-payer socialism in health care? "No insurance, no problem." "It's the cheeseburgers." "2007 is better than 1950." "Socialized medicine! Socialized medicine!"

So there we have it: It's all eyewash. But now let us defer to the observations made not long ago by a prominent economist and observer of health-care reform policies: Under a single-payer system of health insurance, "the public sector... sooner or later [would] have to make key decisions about medical treatment... [and] health care---including the decision about what treatment is provided---[would become] a public responsibility."

And who wrote those words? None other than our friend Krugman, in an exceedingly rare moment of honesty (New York Times, December 26, 2005).

So: Once we agree that under a single-payer system health care services inevitably would be rationed, and that government bureaucrats would do the rationing, and that a number of other not-very-attractive effects inexorably would emerge, the arguments against health-care socialism begin to look a bit less trivial, don't they? What say you now, Professor Krugman?

Thursday, November 08, 2007

The People vs. the Beltway

ABC News, USA Today, and the Kaiser Family Foundation conduct a periodic poll on health care issues, and the findings in the most recent (September 2006) are fascinating. In particular, there is a question on satisfaction with the quality of the health care received by the respondents, of whom 87 percent have health-care insurance coverage, while 13 percent do not. Among all respondents, 89 percent are either very satisfied (52 percent) or somewhat satisfied (37 percent) with their health care. For those with coverage, the respective figures are 56 percent and 37 percent, totaling 93 percent; about 6 percent are dissatisfied.

This means that satisfaction with the quality of health care services actually received among the uninsured can be imputed to be 62 percent. Accordingly, about 37 percent of those without coverage are dissatisfied with their health care.

So: About two-thirds more of the uninsured are satisfied with their health care than are dissatisfied. And bear in mind that even the dissatisfied have access through emergency rooms and other facilities to health care services that are, to be blunt, world class. It may not be very efficient or convenient, but inhumane it is not.

Would someone please tell me why health care coverage for the uninsured in America purportedly is a crisis? Or is the real crisis the difficulty some face in terms of using this issue as a vehicle for wealth redistribution?

[cross-posted from]

Wednesday, November 07, 2007

The Panacea goes Up In Smoke

The voters in Oregon rejected a ballot measure to increase tobacco taxes by 84.5 cents per pack to fund health care coverage for uninsured kids. The vote, in incomplete returns, was about 3:2 against. That's landslide country, folks. I wonder if the Beltway is watching in the context of SCHIP.

[cross-posted from]

Monday, November 05, 2007

And So The Decay Begins

The Centers for Medicare and Medicaid Services announced last week a final rule that will reduce Medicare physician reimbursements by 10.1% on Jan. 1, 2008, unless Congress acts to reverse the reductions, as reported by Congressional Quarterly HealthBeat (November 2). Under the rule, Medicare will pay $58.9 billion to about 900,000 physicians in 2008. CMS officials said that the agency "has no choice but to implement" the rule under current law.

And so just as with Medicaid, the single-payer squeeze on the providers now proceeds apace under Medicare, as politicians and bureaucrats respond to their powerful incentives to reduce budget expenditures at the expense of patients. The longer-run effect of this process is not difficult to predict: Physicians will retire earlier than otherwise would have been the case, fewer will enter medical school and generalized practice, more foreign and fewer experienced doctors will come to characterize medical practice; in short, quality will suffer. Medicare beneficiaries will find it increasingly difficult to find physicians willing to serve them. And so yet again we will come to experience the fruits of government compassion.

[cross-posted from]

One Size Does Not Fit All

The august Los Angeles Times ran an article Sunday by Charles Ornstein on his efforts to help his Mom pick a plan for her Medicare health care and prescription drug benefits, from among the thousands of Medicare Advantage plans and Medigap plans and Part D options and combinations available. The plans are characterized by significant differences in coverages, premiums, co-payments, and all the other attributes that collectively make up health insurance products for seniors.

Ornstein's exasperation is clear given the task of sorting through all the options to find the best one for his Mom. What is clear as well is the utter failure of both him and, as usual, the LA Times to see the forest for the trees: Thousands of options are available because the market---unlike the Beltway---understands and has incentives to respond to the myriad differences in preferences and conditions shaping the health-care choices of millions of American seniors. Would Ornstein be happier with one choice? Well, perhaps, if that choice just happened to be the one fulfilling his Mom's needs most fully. But what are the odds of that?

Ornstein is not alone in his failure to understand that the hassle of sorting through the offerings of the market are nothing compared with the hassle of dealing with government policies and agency bureaucrats who do not have customers to satisfy, and so whose central incentive is to cut budget costs. Would Ornstein be more pleased with a bureaucracy that simply will not spend dollars on given medical services for people older than, say, 75? Don't bet on it. But do bet on that very kind of outcome as a result of socialized health-care finance, if the U.S. ever is sufficiently misguided to adopt such a monstrosity.

[cross-posted from]