News & Commentary
No Compromise on Health 'Reform'
Why the GOP should resist all entreaties to be 'bipartisan.'
by Heather R. Higgins
August 21, 2009
The political winds have shifted dramatically on health care in the
last two months. Suddenly, instead of hearing that legislation is
inevitable, some argue that it can't possibly pass. But that conclusion
is premature, and the odds still favor passage.
The left's previous strategy was to
get the bill passed with as little discussion as possible. Now, along
with a coalition of self-serving corporate interests, it is gearing up
for a fight. Hundreds of millions of dollars will be spent by unions
and the trade association PhRMA on ad campaigns this fall.
This heavy promotion will manifest on
the ground as well; the AFL-CIO just allocated $15 million for
"mobilization and communication," and legislation supporters are being
coached on aggressively interrupting others at town halls as well as
arriving in greater numbers and with more signage to affect media
perception. Contrary to unsupported allegations, the efforts in
opposition to the health-care legislation are relatively modest,
largely voluntary, and funded entirely by individuals.
Most importantly, health "reform" is
the must-pass item for this administration, even more so than cap and
trade or card check. And Democrats have clear majorities in both houses
of Congress, so they can pass legislation of some kind if they can ever
pull their party together.
Republicans augment the chance of
passage with their desire to be "bipartisan." The Democratic strategy
is to take off the table particular proposals that stir up public
outrage-items like the public option, end-of-life counseling, or
mandatory coverage of abortion services. That will be the excuse for
those Republicans who want to seem "reasonable" to come over. The media
will act as though the compromise bill is fully centrist. It won't be.
There are many legitimate concerns
raised by these massive plans, and what you hear depends on who you
ask. If you ask men, they tend to be most concerned about the
legislation's cost and the long-term effect of government controlling
such an enormous share of the economy.
If you ask women, they worry about the
risks of delayed care and the intrusion on their choices. If you ask
the elderly, it is the idea of being pushed to quietly accept the pains
of old age and settle for the palliative pill rather than the new hip.
All these concerns are real and
matter. But the larger point is that Democrats aren't proposing a
subsidy to enable people to get the care they need. Rather they want to
shift decision-making authority from the American citizen to the
government bureaucrat.
These proposals are yet another
manifestation of the no-growth, redistributionist mindset, combined
with an elitist, authoritarian philosophy of government. To buy into
them and ignore the reality they've produced elsewhere is to love
humanity more than human beings, and value utopian ideals of equity
over the tremendous individual costs they inflict.
In these proposals, human beings
aren't individuals with freedom to contract as they see fit and make
their own best judgments, but interchangeable widgets for whom rules
should be fashioned and enforced based on age, or quality of life, or
some other metric. Bureaucrats would evaluate whether one is young
enough to warrant a pacemaker or a hip, or sufficiently long gone from
a hospital to justify readmission. Medicine would become a
one-size-fits-all bureaucracy, not an art, in which the physician would
face real risks for deciding that the bureaucratically approved
"effective treatment" isn't what works in a particular case.
It makes no sense to try to achieve a
bipartisan consensus when the fundamentals underlying the Democratic
approach are so contrary to the entire foundational idea of who we are
as Americans. We're the country that believes that individuals have the
right not to have their decisions interfered with, and that individuals
are best able to make those decisions that most affect their life and
happiness. Nothing could be more central to that than the ability to
control one's own health and the health options of loved ones.
There is much that needs reforming in
health care, and everyone wants to make sure that those who are
genuinely uninsured because of pre-existing conditions, for example,
have access to coverage and care. But the Democratic proposals use
those real problems as a stalking horse to achieve very different
goals. Would-be Republican deal-brokers should stand aside. They need
to understand how the rest of us see this: That this is not just about
the normal compromise of politics, but the core of what America is and
will be.
Once the left's health-care vision is
in place, it will be almost impossible to undo. If this takeover isn't
worth resisting, what is?
Mrs. Higgins is chairman of the Independent Women's Forum.
13 Comments
Tricia | August 22, 2009, 1:28pm | #
I saw this first on the WSJ and the brilliance of Mrs. Higgins arguments and graceful way of putting them forward made me Google IWF and become a member today. The public desperately needs to hear more from the author and other members of this group as your way of framing issues down to the level of the average person is priceless. The public too often gets turned off by overtly political messages which leaves them vulnerable to the murky talking points coming from those pushing the current reform proposals. They are only hearing one side of the story so the debate becomes "either be for the government plans or be against reform" which is absurd. Keep up the good work and keep the articles coming!
Michael Kirkpatrick | August 24, 2009, 7:41pm | #
Excellent article, and some very sound arguements and suggestions for change and overhaul, of which none involve the govt coming into competition with the free market.
Lyn | August 28, 2009, 11:32pm | #
There's only one problem with this article: its underlying premise just isn't true. The author maintains that health care reform removes individuals' "freedom to contract" and gives it to the government.
That is patently false.
Most individuals, with the exception of those wealthy enough not to require health insurance or worry about catastrophic or even chronic illness, have little to no negotiating power when it comes to health insurers and providers. By contrast, health insurers and providers--including local hospitals, doctors, and drug companies--have almost total control over the terms under which they will offer coverage or render health care services. The vast majority of Americans already lack meaningful choice when it comes to "bargaining" with these entities. In any other context, this alone should make the current "contract" between Americans and their health care providers, as referred to by this author, unconscionable.
The author states, "In these proposals, human beings aren't individuals with freedom to contract as they see fit and make their own best judgments, but interchangeable widgets for whom rules should be fashioned and enforced based on age, or quality of life, or some other metric. Bureaucrats would evaluate whether one is young enough to warrant a pacemaker or a hip, or sufficiently long gone from a hospital to justify readmission. Medicine would become a one-size-fits-all bureaucracy, not an art, in which the physician would face real risks for deciding that the bureaucratically approved 'effective treatment' isn't what works in a particular case."
This is a perfect description of how health insurance companies and other providers make decisions about patients' care ALREADY. It's how our system works TODAY. It's what the proposals on health care reform would change--not by removing individual choice, but by leveling out the playing field and setting standards for provider/insurer behavior so that even people without the author's political pull or personal bank account can get a fair shake from the system.
Protecting consumers so that they can have better access to affordable health care IS the stalking horse. Don't make it more than it is, Ms. Higgins. You'd do yourself--and the rest of us--a great disservice.
Suze O | August 29, 2009, 1:52am | #
Well said, lyn
Heather,
It is true that human beings are individuals and not "interchangeable widgets" - and they're not commodities to be collected like shares when they are likely to pay decent dividends, avoided if they look like a risk, or dumped when they start to cost money! That's how we have been treated by medical insurance companies for far too long.
Julane Grant | August 29, 2009, 10:09pm | #
This amazes me! "We're the country that believes that individuals have the right not to have their decisions interfered with, and that individuals are best able to make those decisions that most affect their life and happiness. Nothing could be more central to that than the ability to control one's own health and the health options of loved ones."
And then these same conservatives forever try to deny a woman choice when it comes to her own health. Hypocrisy lives in the conservative brain.
Pat | September 1, 2009, 8:09pm | #
I agree with Suze O...and that what Lynn said is correct...Heather should go back to the drawing board...
David | September 2, 2009, 10:27am | #
The central problem with a health care system operated solely through private insurance is that the basic incentives are wrong. In car insurance, for example, companies can protect against the cost of accidents by collective risks and they can raise the rates of those who represent the highest risk (young new drivers, those who have had accidents, those who have had DUI convictions). Society has accepted this kind of rating system.
This doesn't work (or at least we as a society don't want it to work that way) in health insurance. For example, the older you are the more likely you are (from an actuarial point of view) to need medical care (just like very young drivers are more likely to have accidents), so we have socialized this cost for those over 65 (medicare) because we recognize that private insurers can't or won't do the job without charging excessively high rates. But we also don't like the idea that, if you get sick, your premiums can be raised or you can be dropped by your insurance company (like they can after having an accident in car insurance). Nor do we like the idea of a "life time" maximum benefit, which for many who suffer tramatic injury or illness is the cause for bankruptcy.
But private insurance companies must be profitable. No matter how efficiently they run, they must balance premiums with payouts in such a way to have cash left over for a profit. This is fine when we are buying an automobile, but not so fine when their profit motive clashes with you life/death need for health care. This is why most advanced countries have some form of socialized medicine.
...and don't give me that "don't want a government bureaucrat making my health decisons" argument. While it is not true, even under socialized medicine, that that would be the case, I personally would rather have a neutral, disinterested, well-trained health professional from the government making such decisons than a green-eye shaded accountant from an insurance company who can personally benefit from denying my claim making them.
Tricia | September 4, 2009, 11:14am | #
David,
A lot of folks bring up that same premise about health insurance not being incentivized to care for sick people. Sounds logical but there are problems with this line of thought that need to be discussed as well.
National Review On-Line has a great interview with Michael Cannon from the Cato Institute that you should check out. I've cut and paste it below.
Even if you don't agree with his premise, he does bring an interesting perspective to the debate. We need all of the we can get right now!
Health Care and Freedom
An interview with Cato Institute scholar Michael Cannon.
By Ramesh Ponnuru
Michael Cannon, a health-policy analyst for the libertarian Cato Institute and a co-author of Healthy Competition, recently agreed to answer a few questions of mine for the benefit of NRO readers.
NRO: Is it fair to say that the Democratic legislation on health care amounts to a government takeover of the system? That it amounts to socialized medicine?
CANNON: That’s not only fair to say — it’s imperative to say.
We’re in a dangerous spot where the Obama administration could drop the “government option” and still enact an individual mandate, which is really the most sweeping and dangerous measure in any of the bills before Congress. The individual mandate is itself a government takeover. It would reduce health-insurance choices. It would allow (indeed, require) the government to dictate the content of every health plan in the country; to dictate the relationships between doctors, hospitals, and insurers; to control the prices for health insurance and medical services; and to ration medical care. Sarah Palin’s legitimate (if hyperbolic) “death panels” claim was about the president’s plan to expand Medicare’s existing power to ration care. But the Massachusetts experience shows that the individual mandate would give the federal government that power over non-elderly patients, too. Once the government controls those decisions, what is left to nationalize?
NRO: Mickey Kaus recently asked
some of my conservative friends [to] explain to me just what it is that private insurers do that makes them worth preserving. The central problem, sketched by David Cutler in his book Your Money or Your Life, is that the free market does not reward insurers who provide excellent care. The market punishes insurers who provide excellent care, because the people who will be most attracted by excellent care are sick people, the very people who will drive insurers into bankruptcy. If private firms want to make a profit, at least in the [individual] market, the surest way to do it is to think up innovative ways to screw buyers — deny care to those likely to need it, write complicated clauses into policies that allow the insurer to weasel out of paying, etc. Everyone agrees private insurers do these things. What do they do that’s so great that makes up for it? [Overemphasis in original.]
You insist you’re not a conservative, but can you answer his question?
CANNON: I don’t know Kaus, but it appears that he may be afflicted with the typical laziness that the Left brings to health care: They start with the conclusion that government should run everything, then work backward. Everything that goes wrong is “the market,” even when the problem was created by government. If that’s the way you “reason,” who wouldn’t hate markets?
To respond to Kaus’s concerns, first, the market does not punish excellent care. Government does. Kaiser Permanente and Group Health Cooperative coordinate care, emphasize preventive care, and use electronic medical records to make medicine safer and more convenient. Why have these health plans achieved feats that have eluded Medicare? Because markets promote quality by enabling competition between different ways of paying health-care providers. But government — particularly Medicare — quashes such competition. It favors fee-for-service payment, which penalizes coordinated care, preventive care, electronic medical records, etc. (I recall an exchange with Ezra Klein where he claimed that, because physicians favor fee-for-service payment, the fact that Medicare adopted and used fee-for-service to shape the health sector should be blamed on “the market.” Oy.) It’s ironic that the same folks who say the market punishes excellent care, and who even hail the achievements of Kaiser and Group Health, are trying to drive those same private plans out of Medicare Advantage.
Also, sick people do not drive insurers into bankruptcy — price controls do. So long as insurers can charge actuarially fair rates, they will collect enough money from the sick, and have enough healthy enrollees to cover their costs. The trouble starts when government tells insurers they cannot price insurance according to risk. More sick people show up, and they buy more insurance than they would otherwise. Healthy people see their premiums skyrocket, and they drop out of the market. This is no way to run a railroad. Yet I have never discussed or debated health care with a leftist who didn’t start from the presumption that, of course, government should impose price controls on health-insurance premiums. That’s why they have some sympathy for employer-sponsored insurance: The government imposes on it a (loose) form of price control by forbidding employers to charge different workers different premiums for the same coverage.
In a free market, would private insurance cover all illnesses? Of course not. But fewer people would fall through the cracks than do right now. And let’s remember that the government could be doing a much better job of targeting Medicaid dollars to the needy.
The surest way to make a profit is to screw people? I do hope Kaus puts this theory of his to the test and launches a health-insurance company or a lemonade stand or something that demonstrates how consumers are so stupid that they will sign up for a bad deal, over and over again, never learning from their mistakes. To believe that the surest way to make a profit in health insurance is to screw people is to believe that no one will ever — ever — figure out a way to make binding commitments between insurance companies and soon-to-be-sick consumers. (Never mind that people already have.) And to believe that government provision is the remedy is to believe that binding commitments are possible when one side wields the sole, legal, and unilateral power to breach its commitments. Again, laziness.
Binding commitments and better care at a lower cost — I’d say that’s worth preserving.
NRO: Is government funding for comparative-effectiveness research a step toward rationing?
CANNON: Only in the context of government purchasing medical care. Which happens to be the current context.
NRO: Should people be required to buy health insurance?
CANNON: No. As I suggested earlier, compulsory health insurance is nationalized health insurance, with all that implies for health-care costs and quality.
But the greatest loss would be to individual freedom. As the Congressional Budget Office writes, “A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States.”
The Left’s most powerful argument in favor of an individual mandate — that the uninsured sometimes end up in the ER, unable to pay their bills — isn’t powerful enough. The appropriate response to that problem is not to take away the freedom of non–free riders. The appropriate response is to leave the non–free riders alone, to place the cost of “uncompensated” care on the would-be free riders, and to write off any remaining uncompensated care as the price of living in a free and decent society.
NRO: Is universal coverage a goal legislators should pursue?
CANNON: A threshold question is, Do legislators have the authority? If we’re talking about Congress, the answer is clearly no.
Even if it were constitutional for the government to pursue universal coverage, however, it would still be unwise. You just can’t get to universal coverage in a free-market way. Some people do not want health insurance. The only way to cover them is through coercion, their freedom be damned. The imperative to cover every last person will require massive government intervention, and even people who want health insurance will lose the freedom to choose what their insurance covers. Again, when government compels people to purchase health insurance and dictates what they purchase, costs will climb and quality will stagnate. Free markets will not provide universal health-insurance coverage. And that’s okay, because free markets will reduce unmet need by making medical care more affordable — which also makes it easier to meet what need remains.
What bothers me most about what I call the “Church of Universal Coverage” is its hypocrisy. They claim that compulsory health insurance promotes individual responsibility because it prevents uninsured people from showing up in the ER unable to pay for the care they need. But consider: All members of the Church of Universal Coverage — as well as you and I — want to live in a society where we don’t let people die just because they cannot pay their medical bills. Surely, they recognize that this preference will induce some people to free-ride on their (our) generosity. Yet rather than pay for the predictable costs of their own choices, Church members want to pay for it by taking away the freedom of their fellow citizens. Shifting the cost of your choices onto others is the opposite of personal responsibility.
And these people claim the moral high ground.
NRO: So what should we do about health care?
CANNON: From the beginning of this health-care debate, I’ve argued that the three bad ideas, which must be stopped at all costs, are individual/employer mandates, a new government program, and any expansion of price controls. If we can close the lids on those coffins, we will have scored a victory. (I hold the view that our side can safely ignore the inevitable legislation to “fix” Medicare’s physician price controls. There’s no victory or loss for free markets there.)
If Obamacare fails, all sides will still recognize a need for health-care reform, and free-market advocates should capitalize on that opportunity with a three-pronged strategy. First, we need to change who controls the money. Give each Medicare enrollee a voucher and let him choose any health plan on the market. Give poorer and sicker seniors bigger vouchers, but hold the overall growth in Medicare spending to inflation. That will make Medicare financially stable — without government rationing. Also, reforming the tax treatment of health insurance — “large” health savings accounts are my preference — is not just about reducing distortions at the margin. The tax exclusion for employer-sponsored insurance separates workers from $9,000 of their earnings, gives that money and the power to choose the workers’ health insurance to someone else, and effectively imposes price controls on health-insurance markets. That’s more like a tax than a tax cut. Large HSAs would return that $9,000 to the workers who earned it.
Second, we need to tear down barriers to trade between the states by making state health-insurance and clinician licenses portable. Each state bars from its markets both insurance policies and clinicians licensed by other states. That stifles innovation and protects low-quality state regulators. Congress should use its power under the interstate-commerce clause to tear down those trade barriers. Residents of New Jersey (a.k.a., health-insurance hell) should be able to buy lower-cost health insurance from Pennsylvania. Doctors and nurses licensed by California should be able to practice in other states under the terms of their California licenses. Likewise, health plans like Kaiser that rely on nurse practitioners and other mid-level clinicians shouldn’t have to devise all-new workflows when they want to expand into new states. Those two changes would make health care more affordable and cover tens of millions of uninsured without costing taxpayers a dime.
Third, reform Medicaid and S-CHIP the way we reformed welfare. Medicaid almost perfectly mirrors the old, corrupt welfare system. It encourages states to expand their rolls, and there are too many people on Medicaid who don’t need to be there. Congress should give each state a fixed block of money and the flexibility to target that money to the truly needy. The results will be similar: Medicaid rolls will plummet, and non-needy people will start providing for themselves.
And, generally speaking, conservatives and libertarians need to spend a lot more time educating themselves and the public on health care. This has not been our strong suit, and we are seriously outgunned. Fortunately, we do have the better argument.
Sue | September 6, 2009, 6:35pm | #
This site claims to be non partisan. That is purely misleading. From reading Ms. Higgins arguments, this is an extremely conservative point of view and many of her comments are just plain incorrect and some of the same rhetoric produced and spread by the Republican party intended to scare the ignorant and uneducated in our society. Not a site or agenda I would want to be associated with. As women we should be promoting healthcare for ourselves and our children. Far too many people delay seeing a doctor because they don't have healthcare coverage or are underinsured. I work in a social services environment and see these people everyday. It is time for women to stand up for each other and other less priviledged in our country. Something is better than nothing.
Jeremy | September 8, 2009, 8:47pm | #
Independent...this site and these articles are nothing but a pure mouthpiece for wingnut conservatism. Heaven forbid we should help provide health benefits to all in this country or have a president who goes into school to tell students that it is their personal responsibility to show up, work hard and create opportunities. This site, and you all are purely obstructionists with an opposition agenda. Independent? please.
W0LF | September 9, 2009, 7:43pm | #
I'm kind of floored that an article like this appears on a site who's mission is to present a non-partisan argument. reguardless of Mrs Higgin's leanings this article is a devicive attempt to pit left against right. The fact that she's the chairman says a lot about the IWF's commitment to non-partisanship.
I'm not sure why I'd be surprised that the National Review would miss the point but the public option that the Obama administration is proposing is modeled after health co-ops like Group Health. It's not acceptable to simultaniously criticize their efforts while praising the model they are built from.
There are not two Americas. I don't mean to make a live together, die alone speech but really if we cannot learn to operate in a democracy, if we cannot put the needs of our country above our personal politics, then our country will simply fail.
Porter,M. | September 9, 2009, 8:50pm | #
me,personally, don't understand all the buracracy!! all i do know peoples lives are @ risk here!! they're not things, they're human beings whoworked all their lives paid into health care for when they've gotton old, and can't work, and now because of mis handled funds the governor wants to take it all away! it's outrageous to put our lives in in the hands of those who has mishandled money.
Tricia | September 10, 2009, 1:04am | #
Wolf,
Just wanted to state that I posted the article, not the IWF people. It was in response to David who brought up the statement about insurance companies not being incentivized to cover sick people. It was a bit partisan but it also brought a very different perspective to this subject that you don't hear often which I think it good for this type of debate, for those that may be open to other views anyway.
Coops funded by the government and who are required to follow rules set up by the same government will be a public option with a prettier name.
After the President's speech tonight, it's quite clear that he is hell bent on pushing the existing plans through,whether the country is with him or not (right now, 52% say NO). If he can't put his partisan politics aside for the good of the country, then we all will fail.