Today I’m dealing with the fourth of five issues that I have identified as barriers to accepting ‘socialized medicine.’ One fear, perhaps the main one, is that if medicine is government-controlled, then doctors will lose their incentive to become excellent, and those who pioneer medical technology will lose their incentive to invent new medicines, etc. The capitalist idea (which I think is usually right) is that money motivates people. So the concern is if the free market is taken away, then the money will dry out, and thus, so will the motivation is taken away.
Suppose the government said things like this: “Each hospital will get the same level of funding, regardless of how well or how poorly you manage your facility,” or “Each doctor will be paid the same and keep your job, regardless of how well you do,” or “Each inventor of medical technology will receive the same compensation, whether you do a crappy job or whether you invent a cure for AIDS.” If this is socialized medicine, I agree with the conservative that this would be an unmitigated disaster.
Perhaps the easiest analogy is with public education. I almost regret mentioning public education, because of its well-documented problems and short-comings. Public education is perhaps the paradigmatic case of those who fear government control of institutions, so it is surprising that I am mentioning it. But I am not holding out public education as a shining example of how to do things right; rather, I am merely pointing out some features that a large institution that falls under government control might have. We simply can’t say, “Oh, public education failed in such-and-such a case, and so medicine probably will too.” This is because making sick people healthy who want to be healthy is much different than getting children to excel at math who hate mathematics. So I don’t think we can compare the two except to notice how the government runs large institutions that interface with the population at large.
So, let’s address some of the fears I mentioned in the second paragraph. Has the government abdicated its responsibility to provide enough money for education? No, I don’t think they have. There is plenty of money out there (is it $6000 per child per year now?). Do teachers get to keep teaching even if they perform poorly? No, teachers are fired all the time. Is there a lot of competition for good teaching jobs? Oh yeah, it’s hard to even get a substitute job in some districts. Have education think-tanks stopped trying because the government funds education and not the private marketplace? No, there is a lot of money flying around in research and development of new pedagogical tools. If you invent a new method to teach kids math, or a new science textbook, then you get rich! Just because the money comes from the government does not mean it will be distributed equally regardless of performance.
I will say one more time before I am accused of being insane, NO, I do not believe that public education is a perfect system, even though I like the idea. But I don’t think you can make the analogy between education and medicine, because government control is a much, much more difficult thing to implement at the level of education. Kids just do not want to be in school, and so a lot of the money ends up being wasted. The reason that kids from private schools do (only very slightly) better on their ACTs is probably because kids from wealthy families often have lots of other advantages (like hiring an ACT tutor – just ask me!). There is simply no reason to believe that the field of medicine will no longer be competitive if the government funds it.
5.28.2008
5.18.2008
American Politics Part X
[The end of the “American Politics” blog series is in sight. I’m still working over the topic of ‘socialized medicine,’ which will take up three more blogs, and then I will move to a new topic.]
If you listen to conservative talk shows, you hear a deep disdain for the idea that medical care be controlled by the government. In an attempt to respond, I’ve tried to identify the different phobias that conservatives have, and I’ve come up with a list of five, organized into questions. I think that there are good responses to each of these conservative worries, and since this list of five questions is comprehensive as far as I can tell, I believe that an adequate response to each of these five concerns will show the fear of ‘socialized medicine’ to be unfounded. They are:
1) Isn’t competition between rival hospitals and health care providers necessary for the most effective medical care? (discussed in American Politics, Part VIII;
2) Won’t people become lazy if they get free health care, as is usually the case in a socialistic society? (discussed in American Politics, Part IX)
3) Doesn’t everyone need a personalized health plan? (discussed this week)
4) Won’t health providers lose their motivation to provide quality health care if everything is government sponsored? (to be discussed next week)
5) Hasn’t the government already shown its ineptitude in managing Medicare and medical care for the Armed Services? (to be discussed in two weeks).
But for now, we are treating the conservative worry that everyone needs to have a unique health care plan; just one ‘blanket plan’ will not do. When Bush restructured Medicare in his first term, he put this philosophy into practice by dramatically expanding the number of plan options that seniors had. I don’t have numbers on hand, but I seem to remember that the expansion went from something like four plan options to something like 80. His public defense was simple and straightforward. He said that the reason the system needed an overhaul was because different seniors needed different medicines and thus different plans. This would eventually (somehow – how?) lower the cost of drugs for everyone.
Well, the re-structured plan (like just about everything Mr. 28% Popularity has done) was unpopular. Seniors complained that there were so many options that they had no idea what plan was best for them. “Just go to the internet,” the Administration told the confused seniors. Unfortunately, not only do old people not know how to ‘surf’ the web, but they think a monitor is someone who stands in the hallway to make sure you don’t run or chew gum on school property. And even when they turned to their children for help, the younger generation was just as confused in some cases.
I have since developed an enormous amount of sympathy for this problem. When I was choosing between health plans before we had our second son, I really worked hard to figure out which of the two university plans would cost us less out of pocket. I settled on one, but once we had our child, I found out that the plan I didn’t choose would have saved us about $6,000 out-of-pocket. Why the difference? I have no earthly idea. The premiums were about the same, so why was the level of coverage so different?
There were many hidden technicalities. For example, under the plan that I choose, “circumcision” was listed as an optional procedure for a congenital condition, and thus was not paid for. Is an uncircumsized penis congenital? Yes, I suppose it is something about half of us are born with. But if Kerry would have won in 2004, he would have given everyone a chance to buy into the same insurance package as the Senators have. I would have done that, because I guaran-freaking-tee you that when a Senator has a boy, their insurance pays for the circumcision. I would also be willing to guess that Senator-insurance pays for more than one day in the hospital for those female Senators who arrive at the hospital slightly before midnight (Not a joke – if we would have checked in 10 minutes later, we somehow would have saved $3000).
My point is that there are two things that happen when a system gets complicated: 1) vulnerable people get taken advantage of (as I was when I was not able to properly understand the confusing (because intentionally deceptive) wording in the 30-page brochure for the medical plan I chose), and 2) wealthy people are able to manipulate the system more easily, since a complicated system always has loopholes, and money can always navigate loopholes. There is absolutely nothing good that can come from giving seniors 80+ options for health plans. When everyone has the same health plan, regulated by the federal government, there will be no Plan 36JB7 that pays for circumcisions, while Plan 36JB5 doesn’t. In the case of health insurance, simpler is better. I would be happy to pay the higher premiums of the Senator-insurance-plan just for some peace of mind. I feel like I’m playing Russian Roulette every time I or one of my children visit the hospital. It makes me mad to know that at some time there was a meeting where the insurance company said, "How can we word this in such a way as to make the customer think that we will pay for procedure X when we actually won't?" There will be far less of this kind of deception if everyone had the same policy,
If you listen to conservative talk shows, you hear a deep disdain for the idea that medical care be controlled by the government. In an attempt to respond, I’ve tried to identify the different phobias that conservatives have, and I’ve come up with a list of five, organized into questions. I think that there are good responses to each of these conservative worries, and since this list of five questions is comprehensive as far as I can tell, I believe that an adequate response to each of these five concerns will show the fear of ‘socialized medicine’ to be unfounded. They are:
1) Isn’t competition between rival hospitals and health care providers necessary for the most effective medical care? (discussed in American Politics, Part VIII;
2) Won’t people become lazy if they get free health care, as is usually the case in a socialistic society? (discussed in American Politics, Part IX)
3) Doesn’t everyone need a personalized health plan? (discussed this week)
4) Won’t health providers lose their motivation to provide quality health care if everything is government sponsored? (to be discussed next week)
5) Hasn’t the government already shown its ineptitude in managing Medicare and medical care for the Armed Services? (to be discussed in two weeks).
But for now, we are treating the conservative worry that everyone needs to have a unique health care plan; just one ‘blanket plan’ will not do. When Bush restructured Medicare in his first term, he put this philosophy into practice by dramatically expanding the number of plan options that seniors had. I don’t have numbers on hand, but I seem to remember that the expansion went from something like four plan options to something like 80. His public defense was simple and straightforward. He said that the reason the system needed an overhaul was because different seniors needed different medicines and thus different plans. This would eventually (somehow – how?) lower the cost of drugs for everyone.
Well, the re-structured plan (like just about everything Mr. 28% Popularity has done) was unpopular. Seniors complained that there were so many options that they had no idea what plan was best for them. “Just go to the internet,” the Administration told the confused seniors. Unfortunately, not only do old people not know how to ‘surf’ the web, but they think a monitor is someone who stands in the hallway to make sure you don’t run or chew gum on school property. And even when they turned to their children for help, the younger generation was just as confused in some cases.
I have since developed an enormous amount of sympathy for this problem. When I was choosing between health plans before we had our second son, I really worked hard to figure out which of the two university plans would cost us less out of pocket. I settled on one, but once we had our child, I found out that the plan I didn’t choose would have saved us about $6,000 out-of-pocket. Why the difference? I have no earthly idea. The premiums were about the same, so why was the level of coverage so different?
There were many hidden technicalities. For example, under the plan that I choose, “circumcision” was listed as an optional procedure for a congenital condition, and thus was not paid for. Is an uncircumsized penis congenital? Yes, I suppose it is something about half of us are born with. But if Kerry would have won in 2004, he would have given everyone a chance to buy into the same insurance package as the Senators have. I would have done that, because I guaran-freaking-tee you that when a Senator has a boy, their insurance pays for the circumcision. I would also be willing to guess that Senator-insurance pays for more than one day in the hospital for those female Senators who arrive at the hospital slightly before midnight (Not a joke – if we would have checked in 10 minutes later, we somehow would have saved $3000).
My point is that there are two things that happen when a system gets complicated: 1) vulnerable people get taken advantage of (as I was when I was not able to properly understand the confusing (because intentionally deceptive) wording in the 30-page brochure for the medical plan I chose), and 2) wealthy people are able to manipulate the system more easily, since a complicated system always has loopholes, and money can always navigate loopholes. There is absolutely nothing good that can come from giving seniors 80+ options for health plans. When everyone has the same health plan, regulated by the federal government, there will be no Plan 36JB7 that pays for circumcisions, while Plan 36JB5 doesn’t. In the case of health insurance, simpler is better. I would be happy to pay the higher premiums of the Senator-insurance-plan just for some peace of mind. I feel like I’m playing Russian Roulette every time I or one of my children visit the hospital. It makes me mad to know that at some time there was a meeting where the insurance company said, "How can we word this in such a way as to make the customer think that we will pay for procedure X when we actually won't?" There will be far less of this kind of deception if everyone had the same policy,
5.13.2008
American Politics, Part IX
Last time I pointed to an important dissimilarity between health care and the rest of the marketplace, and this week I want to argue for another important difference. The concern of the capitalist, which I share, is that when people don’t own something, they tend to neglect it in a way that they would not if it were privately owned. Two cheesy, overused, and yet accurate examples: 1) we all know what happens when you get behind the wheel of a rental car. While you don’t trash it, you are harder on a rental car than your personal car, because you are not going to have to deal with the long term consequences of a rental car that needs repaired, and somewhere in the back of your mind, you know that. 2) If you are a homeowner, you know the amazing amount of work and care that you put into to getting your home to look nice and last as long as possible. When it’s your property, you know that its value will drop if not cared for properly, and so you go the ‘extra mile.’
Socialists, of course, advocate a society in which the government owns everything. In this ideal society, there would be no private property, which would mean that there would be complete equality. When Raul Castro took over for his brother recently, he lifted the long-standing ban on cell phones. Why did Fidel ban cell phones? Because if some people had cell phones and some did not, that would make society unequal. I hold the same line of reasoning that all people from capitalist societies hold: great idea, doesn’t seem very practical. I am a liberal, but I am not a socialist – I think private property, in most situations, is a good thing for the reasons that are underlying those two previous examples. Even the best of us just don’t treat things with the same level of care when we are not dealing with our own property.
So what about ‘socialized medicine?’ If we reject socialism, shouldn’t we also be opposed to socialized medicine, where health care and insurance is totally controlled and paid for by the government? Conservatives, it seems, make this association. After all, they may reason, if you are the one who has to pay for your broken foot, you will careful to put on work boots when you’re working with heavy machinery. But if the government pays for whatever maladies you develop, you will tend to be less careful with your own health. The government just “bails you out” of whatever situation you got yourself into. This, I think, is part of why conservatives get their pitchforks when they hear about government-sponsored health care.
But this reasoning doesn’t hold. I agree with the conservative that we should not let the government own, for example, houses. But I predict that the smoking rate, for example, will not go up if health care is free. Conservatives are afraid of a government bale out system, where people will just start lighting up and let the government pay for their lung surgery later on in life. My prediction is that something like this will not happen. Unlike a dilapidated house, which I can just walk away from and let it be the government’s problem, I cannot walk away from my body. My health is already something I care very much about (or else someone already doesn’t really care – like the chain smoker). Those of us who don’t think that socialism can be as effective as capitalism agree that people, because of their nature, need some kind of incentive to take care of something. That is true for my house, but I don’t need an extra incentive to take care of my health. This is yet another important dissimilarity between socialized medicine and anything else the government might control, and yet another reason to think more critically about how we could institute ‘socialized medicine’ in a healthy, creative way in our capitalistic society.
Socialists, of course, advocate a society in which the government owns everything. In this ideal society, there would be no private property, which would mean that there would be complete equality. When Raul Castro took over for his brother recently, he lifted the long-standing ban on cell phones. Why did Fidel ban cell phones? Because if some people had cell phones and some did not, that would make society unequal. I hold the same line of reasoning that all people from capitalist societies hold: great idea, doesn’t seem very practical. I am a liberal, but I am not a socialist – I think private property, in most situations, is a good thing for the reasons that are underlying those two previous examples. Even the best of us just don’t treat things with the same level of care when we are not dealing with our own property.
So what about ‘socialized medicine?’ If we reject socialism, shouldn’t we also be opposed to socialized medicine, where health care and insurance is totally controlled and paid for by the government? Conservatives, it seems, make this association. After all, they may reason, if you are the one who has to pay for your broken foot, you will careful to put on work boots when you’re working with heavy machinery. But if the government pays for whatever maladies you develop, you will tend to be less careful with your own health. The government just “bails you out” of whatever situation you got yourself into. This, I think, is part of why conservatives get their pitchforks when they hear about government-sponsored health care.
But this reasoning doesn’t hold. I agree with the conservative that we should not let the government own, for example, houses. But I predict that the smoking rate, for example, will not go up if health care is free. Conservatives are afraid of a government bale out system, where people will just start lighting up and let the government pay for their lung surgery later on in life. My prediction is that something like this will not happen. Unlike a dilapidated house, which I can just walk away from and let it be the government’s problem, I cannot walk away from my body. My health is already something I care very much about (or else someone already doesn’t really care – like the chain smoker). Those of us who don’t think that socialism can be as effective as capitalism agree that people, because of their nature, need some kind of incentive to take care of something. That is true for my house, but I don’t need an extra incentive to take care of my health. This is yet another important dissimilarity between socialized medicine and anything else the government might control, and yet another reason to think more critically about how we could institute ‘socialized medicine’ in a healthy, creative way in our capitalistic society.
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