Virginia Postrel says do Medicare first:
Think about this for a moment. Medicare is a huge, single-payer, government-run program. It ought to provide the perfect environment for experimentation. If more-efficient government management can slash health-care costs by addressing all these problems, why not start with Medicare? Let’s see what “better management” looks like applied to Medicare before we roll it out to the rest of the country.
This is not a completely cynical suggestion. Medicare is, for instance, a logical place to start to design better electronic records systems and the incentives to use them. But you do have to wonder why a report that claims that Medicare is wasting 30 percent of its spending thinks it’s making a case for making the rest of the health care system more like Medicare.
Because they think we’re rubes. And judging by the voting results last fall, many of us are.
This reminds me of the old Soviet joke (that I’m sure I’ve related at this blog, perhaps more than once, but it remains appropriate). A teacher is lecturing schoolchildren on the brilliance of Karl Marx. A kid raises his hand, and says, “Teacher, was Marx truly a great scientist?” She beams and nods, and declares him the greatest scientist in the history of mankind. “Well,” he went on, “then why didn’t he try this crap on rats first?”
[Saturday afternoon update]
Peter Orszag has responded to Virginia’s question. Hail the blogosphere.
I find this quite telling:
Medicare First–changing Medicare and waiting to see how it works before messing around with the rest of the health care system–won’t work politically.
You don’t say…
Some people might think that cause to rethink. But not these people.
[Bumped]
They are doing Medicare — click my name.
If so, then we’ll wait to see the results. Then we’ll talk about imposing it on everyone.
If so, then we’ll wait to see the results. Then we’ll talk about imposing it on everyone.
No one is talking about imposing anything on everyone. They’re talking about starting with the currently uninsured and with Medicare. Why don’t you and Postrel know this?
Yes, they are talking about imposing various plans on everyone. Even subsidies for the uninsured can be an imposition on everyone, if they cause people to abandon other alternatives via what is, essentially, unfair competition by the government entity.
Yours,
Tom
Your disenguity is breathtaking, as always, Jim.
While entitlements have always been as source of getting and maintaining congressional power, the interesting point from the WaPo articles cited by Jim is that this may transfer to the executive branch. In theory an independent MedPAC board would be a good thing, however I’m very suspicious of the continuing concentration of power into the executive branch.
I’m suspicious of the concentration of power into the government, period.
Your disenguity is breathtaking, as always, Jim.
Show me any aspect of the Obama Health Reform effort that they say they will impose on everyone.
Show me any aspect of the Obama Health Reform effort that they say they will impose on everyone.
If I were so clueless and naive as to assess what the Obama administration based on what it says, as opposed to what it actually does, and not on the obvious and inevitable consequences of what it says it will do regardless of what it says about that, I might have voted for it.
But that’s not the way I roll…
The fact it’s called “health reform” yet involves the government. Coupled, as Rand alludes, to history, that sets it in stone regardless of what anybody might claim to the contrary.
Political analysis is no doubt easier if you can skip past the dreary business of actual proposals and legislation, and jump straight to the products of your fevered imagination.
Political analysis is no doubt easier if you can skip past the dreary business of actual proposals and legislation, and jump straight to the products of your fevered imagination.
Sorry, but our assessments are based on what the proposals are, and what the inevitable consequences of them will be. Unlike you (to be generous to you, because to think otherwise would be to imply that you are as duplicitous as they are), we aren’t rubes.
our assessments are based on what the proposals are
How can that be when you (and the people you cite, like Ms. Postrel) are so ignorant of what those proposals are?
and what the inevitable consequences of them will be
And here is where your imagination gets to have some fun.
How can that be when you (and the people you cite, like Ms. Postrel) are so ignorant of what those proposals are?
When are you going to stop beating your kids?
If it takes a personal email for Ms. Postel to recognize the existence of the administration’s cost-cutting plans for Medicare, then yes, I think it’s fair to call her ignorant of the administration’s proposals.
Hey Jim, do you get paid for posting this stuff?
Mebbe there’s a secret organization that we’ve never heard of, sort of like magazines that used to pay authors by the word. And they pay by the post. That would explain a hell of a lot of troll posts.
Before Medicare, let’s try to fix the ultimate in single-payer health care systems: the VA Hospitals.
Funny that the same political persuation that argues against even working out the kinks in their grand collectivized healthcare scheme in the limited areas where it already exists before inflicting it on everyone often argues that humans can’t possibly colonize space until we’ve cleaned up our environmental “mess” here on Earth, renounced all forms of conflict in favor of some undefined “peace”, and perfected justice and equality for all.
We have to have perfected human nature before we get to settle space, but they get to collectivize healthcare with “trust us: put everyone in the system and then we’ll find a way to make it work”.
People like Jim just make me sick. He has no right coming in here and proposing he evil intents. He is doing precisely what collectivists do so well. Twisting things around to make it seem like, we are the ones that are not getting with the program. We are the ones that have the failure of logic. No, he is mincing words and playing games with meanings. He is the one that is purposely degrading the intellectual level of the discussion to a point that which his ideals have a remote possibility of gaining traction. Don’t fall into his digger trap. Eventually you lose footing and fail to connect with the true purpose of individual choice and freedom. This is not a type of direct type of assault on his part, this a subtle bending at the edges. This is a type of intellectual subterfuge. Don’t give them an inch, not a single bit.
Hey Jim, do you get paid for posting this stuff?
Alas, no. But I do get the satisfaction of offering a different perspective and (often) new information.
Before Medicare, let’s try to fix the ultimate in single-payer health care systems: the VA Hospitals.
That brings to mind the recent observation by Ezra Klein (click my name for the reference):
We have to have perfected human nature before we get to settle space, but they get to collectivize healthcare with “trust us: put everyone in the system and then we’ll find a way to make it work”.
For whatever it’s worth, I don’t think we need to fix Earth before settling space. In fact I think that settling space will make it easier to address issues on Earth. Some of the reasons are technology spinoffs, scientific advances, off-Earth resources, etc. But I think the biggest one is that, as a space faring civilization, we will have a different perspective on our home planet, and that perspective will make us better at taking care of it.
People like Jim just make me sick. He has no right coming in here and proposing he evil intents.
No, I don’t have the right, but I’m grateful that Rand affords me the privilege.
Just because your perspective is “different” doesn’t make it better. Or correct. Or interesting.
“worst-functioning to best”
By what objective measure?
I think all one has to do to refute the assertion by Klein that his order of best to worst functioning of health delivery systems is obviously wrong is to consider the source.
Having experience with all of the named systems, when it came to the need for some surgery last year I happily paid three times the *private* market rate to get the best surgeon in the country. I shudder to think what would have happened if I was restricted to Medicare or VA.
By what objective measure?
Survival rates, odds of a patient getting the recommended treatment for his/her illness, etc. Follow the link to Philip Longman’s book on the VA for more detail and studies.
I think all one has to do to refute the assertion by Klein that his order of best to worst functioning of health delivery systems is obviously wrong is to consider the source.
He is a full-time writer on health policy, what could he know?
I happily paid three times the *private* market rate to get the best surgeon in the country.
And you can go on doing that. But anecdote is not data, and one unusually expensive and skilled surgeon is not a scalable answer to our health care issues.
To draw a space policy analogy: no doubt you could find astronauts who are very glad they rode the shuttle, and who would shudder at the prospect of putting their lives in the hands of a Rotary Rocket, Kistler, Rocketplane, XCOR, SpaceX, Armadillo, etc. That doesn’t make the shuttle the best approach to putting people in space.
“He is a full-time writer on health policy, what could he know?”
*Liberal* writer on health policy.
And I don’t want the “recommended” treatment that is mandated by some government bureaucrat. I want the treatment I want, and I’ll pay for it myself.
“And you can go on doing that.”
Not with the direction “health care reform” is headed.
Not with the direction “health care reform” is headed.
The idea that any step towards universal health insurance means that we will inevitably turn into Canada is not based in reality.
Every wealthy country on earth has national health insurance, except for the U.S. Of those there is exactly one that bans private health care: Canada. There are dozens of national health systems that don’t, and every reason to expect that we’d be another.
One of the reasons Canada can politically sustain its private care ban is that the U.S. is next door; it is a pressure relief valve for the small fraction of Canadians who want care outside the national system.
I would say that about the idea that it won’t.
If medicare and/or the VA are so great, why aren’t govt employees in it? Why aren’t they demanding to join?
While you’re at it, let’s include state and local govt employees.
Here’s my proposal. Give Obama free rein over govt healthcare. However, his program has to cover all govt employees and the current recipients. (Yes, state and local govt too.) And, starting in 2011, the per-person budget gets cut 5% year for four years. (Since he’s promising 25-30% savings, this should be easy.)
Somewhere in here, we open it up, at cost, to cost-plus contractors and limit their reimbursements to said cost.
Obama can choose whether to delegate to states, but if he does, said state runs all govt medical. Otherwise, the fed does.
If Obama is correct, in a couple of years, govt employees will be living forever and he’ll have half of the promised savings. (The US govt currently spends about as much as the private sector to cover the same number of people.) If not, they’ll rebel.
I note that the Indian Health Service isn’t being mentioned….