July 25, 2006
Senator Tom Coburn on Healthcare Reform
At the Northeast Conservative Conference of the National Federation of Republican Assemblies held this past weekend at the Crowne Plaza in Warwick, I asked Senator Tom Coburn of Oklahoma what the Federal government's first step towards reforming health insurance in America should be�
Senator Tom Coburn: You can't tinker around the edges anymore. We have X-amount of resources to give to healthcare. The more of our total national income we put in healthcare, the less competitive we will be in the world. So how do we deliver healthcare best? We create a consumer driven, transparent healthcare market. The first thing we should do is pass John Shadegg and Jim DeMint's bill so you can buy your insurance anywhere you want.
I'll give you an example. In Oklahoma you can buy a family policy with a 500 dollar deductible for a year for 1200 bucks. That same policy costs 5900 dollars in New Jersey. Why should it cost 4 to 5 times as much? It's because they have 155 mandates that must be covered in New Jersey. What if I don't want to buy that?
We haven't allowed market forces to allocate resources. That requires some changes. That doesn't mean you give up state lines. The health industry is going to still have to report to the states, they will still have to pay into uncompensated funds in the states, but freedom should be given back to individual Americans. That will create innovation. That will get a lot of people insured who can't afford to buy insurance in New Jersey today -- they will have catastrophic coverage.
We're going to be introducing something in October and November that totally reforms healthcare across the country.
What you don't do is allow the Federal Government to try to design interoperable standards for healthcare IT, which they've been doing for two years to the tune of 160 million dollars and don't have anything yet. What you do is put 3 or 4 great software companies in the country in a room and say here's the money, go fix it and get it back to us. What they tell me is they could have something in 4 months, if we gave them 10 to 15 million dollars to do it, yet the government has already spent 2 years and 160 million dollars. Health IT is one of the places where we would save lives, cut costs, and increase innovation even further, but we've decided that government must design the system. Why?
You guys should read BusinessWeek once in a while. You know, that commie-pinko-left-wing rag, BusinessWeek? Those corporate-types that read it are all commies, you know.
If you did, you would know that the best-run medical establishment in the USofA is the Veterans' Administration. And the best part?
It's pure socialized medicine.
Like, the real deal, beyond what Canada or England has.
Let me repeat that: the BEST, most efficient, most effective medical system in the whole country is SOCIALIZED medicine. The doctors, nurse, & everyone else are employees of the government.
The problem with our health care non-system is that the market has screwed it up. The corporations that run health insurance have the market cornered, and they've proceeded to dictate how medicine is dispensed, and, largely, to whom. No doubt NJ has more mandated coverage than OK; however, the OK insurers are telling the public what medicine is, and what it isn't.
Out of curiousity, I wonder what the average out-of-pocket cost is to an OK resident (after the "insurance" has paid its share) vs the OOP in NJ. Want to bet the OK resident pays a whole bunch more?
Market forces? Sorry. Socialized medicined beats it hands down.
BTW, the article on the VA is in either the 7/17 or 7/24 issue of BusinessWeek. That is called "evidence," or "proof."
Posted by: klaus at July 25, 2006 7:50 PMThe answer isn't more socialism ... it's less government interference, and more free market. For every country to cite as a heathcare utopia, I can name many reasons why their systems are generally inferior to ours. They may be good on the small stuff, but it you need major work done, no one beats the USA. Right now, we have a system that stifles innovation, drives up prices, and doesn't really work well for anyone (except of course, shareholders).
Posted by: Will at July 26, 2006 12:39 AMTom,
Did you read the article? The VA is the best, most efficient, most cost-effective medical system in the country.
It's the "free market" "systems" that don't work.
And there is no health care utopia. Get real. However, the US spends more money than anyone else, and gets mediocre (that's being generous) results. The British spend much less, but lower-class Britons are generally healthier than upper-class Americans. And the correlation between class/income level is well established. That is, the higher your income, the better your health--within the same health-care system.
So, Tom, basically you are flat wrong. Our system is the bad example. You cite urban legends, not facts. The myth of waiting lines (tried to get an appointment with a dermatoligist lately?) and inferior care are, to be blunt, not true.
The truth, as shown by many, many studies is that universal health care works better and costs less than the mess we've created. There may be bad aspects to the various systems, but, overall, they perform way, way better at half or a quarter the cost.
Posted by: klaus at July 26, 2006 6:18 PMKlaus:
You assert that the “free market” system of health care is broken. You’re wrong – there is no longer a “free market” health care system! Between Medicare, Medicaid (and its spawn like RiteCare) the government now runs at least half of the healthcare system. Moreover, the “private” side is subsidizing the “public” side through what is known as “cost shifting,” i.e., government reimbursements don’t cover actual costs, so medical providers make up the difference by shifting the cost to the private side.
It’s no coincidence that medical inflation has risen concurrently with the rise in “government provided” health care … not to mention the impact of the increasingly ubiquitous ambulance chasers, the Democratic Party’s favorite moneybags.
Restoration of a true free market in healthcare would provide all the benefits that free markets provide in all realms – increasing quality and competitive prices.
Tom, look. You make assertions based on orthodox theory. You have no facts to back up your contention. The only thing that market-based health care would accomplish is the complete destruction of American health care. So few people would be able to pay that doctors would drop out of the market in droves, driving the price up, not down.
What do you think would happen if you had to pay full-freight for care? If you want to answer that, look at the bankruptcy stats. Prior to the change in the law, over half of all declared bankruptcies involved medical expenses. Because people can't afford to pay for coverage. If they can't pay for it now, how will that change?
Is the cost of an MRI, or a blood test, or rent on the building suddenly going to drop because of "market forces"? No. What will happen is that doctors don't get paid, providing a huge disincentive for people to enter the profession. It's already happening with thoracic surgeons (Per a report on Nightly Business Report, 7/6/06) because the Medicare reimbursement payments have been SLASHED so drastically.
I'll repeat: the gov't has CUT reimbursement.
Kind of undercuts your contention about prices rising because of gov't interference, doesn't it?
And remember, median wages are stagnating, so it's not like people are moving up the social scale, either.
And, the universal coverage schemes in various countries all cost way, way less than our system. How do you square that with your 'free market' mantra?
The gov't in other countries has interfered much more than it has here and the prices for their services has gone DOWN.
Again, how to square that with your 'free market' orthodoxy?
All this stuff about the market is nothing more than a belief, completely unsupported by facts. Again, read BusinessWeek's article. The VA is the most cost-effective system in the country, with the lowest admin costs. How do you square that with the free-market ideology?
Posted by: klaus at July 27, 2006 8:22 PM>> What will happen is that doctors don't get paid, providing a huge disincentive for people to enter the profession. It's already happening with thoracic surgeons (Per a report on Nightly Business Report, 7/6/06) because the Medicare reimbursement payments have been SLASHED so drastically. I'll repeat: the gov't has CUT reimbursement. Kind of undercuts your contention about prices rising because of gov't interference, doesn't it?
Klaus,
The above is a precursor of what will happen with “single payer” and the shortages that are part and parcel of socialized medicine schemes (e.g., Canada).
What you assert are “prices” going down in a government-run system is a fallacy. THERE ARE NO “PRICES” IN A GOVERNMENT RUN SYSTEM. The government dictates reimbursement rates, as in the example above that you so inadvertently provided.
The health care system in this country worked just great before the government got involved in the 1960’s (Medicare and Medicaid). The problems have arisen since then, and are getting worse commensurate with government’s growing involvement (Medicare / Medicaid are now something like 60% of all health care spending in this country … and this doesn’t include cost-shifting).
Timothy Leary on his wildest trip wouldn’t even buy the notion that putting the federal government in charge of health care would result in lower “prices” and quality services.
Unions want “single payer” because it’ll mean more actual and de facto government employees – and the public sector is the only area in which the unions show growth. Democrats and their sycophants support it because it furthers the creeping transformation of America into a socialist state – recall that HillaryCare intended to ban private health care entirely – expanding government and promoting “equality” by forcing all of us into a low-quality, but “universal,” health care system.
If I'm wrong, why is our infant mortality rate somewhere below that of Cuba?
Why do we spend so much more than the British and get much worse results?
Why do we spend so much more on health care than every other county, including those with with universal coverage and rank something like 50th in life expectancy?
Can you answer those questions?
Can you address those questions?
They are very simple. I am providing data to support my point. Refute it with data.
Until you can provide something like evidence, then my points stand. All you do is tell me I'm wrong, without citing anything but market theory. And what does Tim Leary have to do with this? Stick to the point, and present some data, please.
Prove to me that Canadians have longer waiting lines, etc. That's the Rush Limbaugh talking point. Problem is, it ain't true.
We have rationing. We have waiting lines. Rationing: people with good jobs get all the coverage they want. People without go to the emergency room when a something that could have been treated with $3 worth of antibiotics is now life-threatening.
Waiting Lines: try getting an appointment with a specialist in anything less than three months.
Shortages: remember the flu vaccine fiasco in Canada two years ago? Oh, wait, that was here in the US.
What exactly are we better at, other than spending more and getting less. Wow, what a bargain.
And you mentioned how cheap medicine was prior to the Medicare in the 1960s.. Um, let's see...the increase in prices couldn't have anything to do with the increase in technology, could it? No, of course not. MRIs don't cost more than X-rays, do they? Arthoscopic surgical equipment is just as cheap as a regular scalpel, isn't it?
I demonstrated that the cost of medicine has gone down because of gov't intervention, here and elsewhere.
The facts support my position.
Quoting me, you claim that socialized medicine will create shortages because the price of medicine will go down.
Then you claim it's gone up because of gov't intervention with Medicare. Which is it?
Is that the extent of your "data"? Because you've contradicted yourself.
See, whether you realize it or not, you're talking about "moral hazard." Since it's cheap, we use more of it. Right. Let's see, I can play golf, or go to the doctor. Hmmm...since the doctor is free, I'll go to the doctor.
Right.
Klaus:
You haven’t given facts, just assertions. Cite some independent and objective sources.
In recent months there was an article – I think in the Wall Street Journal, but it could have been elsewhere – concerning the fact that folks in Great Britain have a hard time obtaining dental care because the “universal” government system’s reimbursements are so low that dentists are refusing to take new patients that aren’t “private payer.” (Which explains why HillaryCare sought to ban any form of non-government health care in this country.)
Shortages and declining quality are part and parcel of socialized medicine (or socialized anything for that matter). Government bureaucrats who are insulated from the consequences of their actions make like and death decisions regarding what procedures will be covered; when; which drugs are on an “approved” list, etc.etc. – and the poor “patient” has no alternative. Similarly, the “best and brightest” will no longer go into medicine – investing years in an expensive education, merely to come out and be moderately paid de facto civil servants.
The Canadian health care system is a mess. In fact, in the last year or two their Supreme Court issued a decision (I forget the details) essentially requiring the government to start permitting people to seek private alternatives because the government system is becoming increasingly dysfunctional. Many Canadians also come to the U.S. to e.g., obtain MRI’s because they waits in Canada are so long.
Mortality rates etc. are impacted by the quality of health care, but there is not a direct correlation. U.S. mortality rates are also impacted by our increasing rates of obesity and lack of physical activity. Ditto gang violence in the inner cities.
And what’s this nonsense about “the uninsured?” It’s a red herring fostered by those who want to socialize medicine (and ultimately the rest of the economy). There’s the welfare programs of Medicaid / RiteCare / Medicare … and nobody is denied hospital care.
To think that the U.S. government – you know, the folks in charge of FEMA / Katrina and Pentagon procurement – could even theoretically run health care better than a private system is as delusional as believing the “public schools” are doing a better and more cost-effective job than “private schools” or that Social Security as presently constituted will remain viable over the long run.
The answer is free market competition – employees and other health care consumers selecting among competing insurers, making informed choices via “Consumer Reports” like ratings of service etc.
And if you want to help lower income people purchase insurance great – but do it through a United Way contribution from your paycheck instead proposing yet another dysfunctional and ineffective welfare program.