Healthcare Forum, Part 1

On Monday, I attended a candidate's forum sponsored by the Rhode Island Health Center Association. Federal candidates Lincoln Chafee, Jon Scott, Rod Driver, Sheldon Whitehouse, Patrick Kennedy and James Langevin; and state candidates Don Carcieri, Reginald Centracchio, Charles Fogarty and Elizabeth Roberts all gave answers to questions about health care asked by moderator Bill "Rap Man"(*) Rappleye of WJAR-TV.

Felice J. Freyer reported on the forum in the Projo. The tone of her article suggests that, taken as a whole, she wasn't exactly blown away by the answers to the questions that she heard...

Given impending cuts in Medicaid on the federal level, Channel 10 (WJAR) political reporter Bill Rappleye asked, would you use state money to fill the gaps, or would you prefer to increase fees or limit eligibility in a state-run health program for the poor and disabled....

Of the 10 candidates at the Rhode Island Health Center Association's annual meeting, only one or two (depending on how you take their answers) would go on record favoring either of these unpopular options.

Governor Carcieri, a Republican who is running for reelection, said he has appointed a team to look for ways to save money in Medicaid....Rodney Driver, an independent running for U.S. House in the second district, against U.S. Rep. James Langevin, favored having the state make up any federal losses in Medicaid funding. The state can do this by cutting back on waste, fraud and abuse within the budget, Driver said.

The other candidates did little more than decry the Medicaid situation. Medicaid, which is financed jointly by the state and federal governments, is a growing portion of state budgets as medical costs increase and the number of uninsured people grows.

There were few specific, direct answers to any of the three questions posed to each candidate....

Mr. Freyer quotes Sheldon Whitehouse's call for universal coverage of some sort...

It's a system that is screaming out for reform....We simply have to get universal coverage.

Former Attorney General Whitehouse wasn't the only Democrat at the forum who supports a so-called universal solution. Congressman Langevin and Senator Roberts both mentioned the goal universal health care in their responses. Congressman Kennedy talked about healthcare as a moral problem. And Lieutenant Governor Fogarty has put forth a proposal for mandatory health coverage for all Rhode Islanders as part of his campaign.

The unanimity on universality may be the cause of the lack of specifics that Ms. Freyer decries, at least on the Democratic side. Democrats invoke "universal health care" like the words themselves are a magical incantation that will solve the problem. (To be fair, Congressman Langevin does have specific ideas about extending the health plan offered to Federal employees to all citizens, and Lieutenant Governor Fogarty has put forth a plan similar the Massachusetts mandatory-coverage plan that is detailed in its implementation, if not in how it will be funded). But when Sheldon Whitehouse, or Patrick Kennedy, or Elizabeth Roberts use the term "universal", we don't know quite what they mean, because universal coverage can mean many different things...

• At one extreme, universal coverage could mean a single-payer, government run system where government insurance is the only health insurance allowed and supplemental insurance is made illegal.
• At the other end, universal coverage could also mean a government run system as a base, with people allowed to purchase additional coverage from a private system. (I think, for example, this is what a country like Australia does).

In our current political system, it is hard to envision programs based on either of these ideas being run well. The first idea is based on the assumed effectiveness of healthcare rationing -- the government needs to reduces the quality of health coverage for some people in order to obtain the resources necessary to provide coverage to others. This kind of central planning has a long history of not working.

The second idea, while blunting the effects of rationing in theory, would most likely lead to a system with some people being stuck in a poor-quality government program, others paying for better quality private coverage, and a never-ending political tension for new "funding formulas" to transfer more resources into the government program. In short, government would do to health care what it's done to public education over the past forty years.

The important thing to bear in mind is that the mixture of public and private in any healthcare reform is not a "detail that needs to be worked out", it is a choice that needs to be made up front. Politicians who favor universal care need to be honest with the public about exactly what they are proposing...

(*)I'm just reporting how the hosting organization referred to their esteemed moderator.