The Ethos of Universal Coverage
Associated Press photojournalist Noah Berger captured this thousand-word image near the Occupy Oakland demonstrations last month.
(AP Photo/Noah Berger)
Many Cato@Liberty readers will get it immediately. They can stop reading now.
For everyone else, this image perfectly illustrates the ethos of what I call the Church of Universal Coverage.
Like everyone who supports a government guarantee of access to medical care, the genius who left this graffiti on Kaiser Permanente’s offices probably thought he was signaling how important other human beings are to him. He wants them to get health care after all. He was willing to expend resources to transmit that signal: a few dollars for a can of spray paint (assuming he didn’t steal it) plus his time. He probably even felt good about himself afterward.
Unfortunately, the money and time this genius spent vandalizing other people’s property are resources that could have gone toward, say, buying him health insurance. Or providing a flu shot to a senior citizen. This genius has also forced Kaiser Permanente to divert resources away from healing the sick. Kaiser now has to spend money on a pressure washer and whatever else one uses to remove graffiti from those surfaces (e.g., water, labor).
The broader Church of Universal Coverage spends resources campaigning for a government guarantee of access to medical care. Those resources likewise could have been used to purchase medical care for, say, the poor. The Church’s efforts impel opponents of such a guarantee to spend resources fighting it. For the most part, though, they encourage interest groups to expend resources to bend that guarantee toward their own selfish ends. The taxes required to effectuate that (warped) guarantee reduce economic productivity both among those whose taxes enable, and those who receive, the resulting government transfers.
In the end, that very government guarantee ends up leaving people with less purchasing power and undermining the market’s ability to discover cost-saving innovations that bring better health care within the reach of the needy. That’s to say nothing of the rights that the Church of Universal Coverage tramples along the way: yours, mine, Kaiser Permanente’s, the Catholic Church’s…
I see no moral distinction between the Church of Universal Coverage and this genius. Both spend time and money to undermine other people’s rights as well as their own stated goal of “health care for everybody.”
Of course, it is always possible that, as with their foot soldier in Oakland, the Church’s efforts are as much about making a statement and feeling better about themselves as anything else.
‘Medicare Loses Nearly Four Times as Much Money as Health Insurers Make’
The latest from Jeffrey H. Anderson, which I’ll file under I-Wish-I’d-Said-That:
In a newly released report, the Government Accountability Office (GAO) estimates that, in fiscal year 2010, $48 billion in taxpayer money was squandered on fraudulent or improper Medicare claims. Meanwhile, the nation’s ten largest health insurance companies made combined profits of $12.7 billion in 2010 (according to Fortune 500). In other words, for every $1 made by the nation’s ten largest insurers, Medicare lost nearly $4…
Actually, it may have been even worse than that: The GAO writes that this $48 billion in taxpayer money that went down the drain doesn’t even represent Medicare’s full tally of lost revenue, since it “did not include improper payments in its Part D prescription drug benefit, for which the agency has not yet estimated a total amount.”
Courtesy of The Weekly Standard.
‘Democrats Guess Wrong on Health Care’
That’s the headline of an article posted this week in Politico:
Rarely have so many political strategists been so wrong about something so big.
But when it comes to the health care bill, everyone from former President Bill Clinton on down whiffed on some of the more significant predictions.
Democrats would run aggressively on the legislation? Nope. Voters would forget about the sausage-making aspects of the legislative process? Doesn’t seem that way, as the process contributed to the sense that the bill was deeply flawed.
And Clinton’s own promise to jittery Democrats that their poll numbers would skyrocket after the bill finally passed also didn’t pan out, as the party is fighting for its life in the midterms.
What can explain the miscalculation? Maybe religious fervor?
Senators (Finally) Press Kagan about ObamaCare
Back in May, I suggested:
Senate Judiciary Committee members should be sure to ask Solicitor General and Supreme Court nominee Elena Kagan, during her upcoming confirmation hearings, whether she or her office played any part in crafting ObamaCare or the administration’s defense to the lawsuits challenging that law. If Kagan helped to craft either, that would present a conflict of interest: when those lawsuits reach the Supreme Court, she would be sitting in judgment over a case in which she had already taken sides…
If Kagan played a role in drafting ObamaCare or formulating the administration’s legal defense, and is confirmed by the Senate, propriety would dictate that she recuse herself from any challenges to that law that reach the high court.
Committee members didn’t ask her those questions during the hearings, as The Wall Street Journal explains. Fortunately, a letter to Kagan from all seven Republicans on the committee has (exhaustively) remedied that oversight.
Kagan has already told the committee she would recuse herself from any case in which she “participated in formulating the government’s litigating position.” Given that she appears to take an expansive view of Congress’ power to regulate interstate commerce, the best possible outcome for opponents of ObamaCare would probably be for Kagan to join the Court but recuse herself from cases challenging that law.
That would also be the worst possible outcome for the administration. In fact, universal coverage is so important to the Left that if Kagan would leave them with one less pro-ObamaCare vote on the Court, I wouldn’t be surprised to see President Obama withdraw her nomination. He could then appoint someone as ideologically reliable as Kagan, but who could actually defend the president’s signature accomplishment.
This could get interesting.
Filed under: Cato Publications; General; Health Care; Law and Civil Liberties
Rwanda and the Psychic Benefits of Universal Coverage
Last week, The New York Times published an article subtitled, “In Desperately Poor Rwanda, Most Have Health Insurance.” The main theme was the contrast between Rwanda’s compulsory health insurance system and the as-yet-non-compulsory U.S. health insurance market:
Rwanda has had national health insurance for 11 years now; 92 percent of the nation is covered, and the premiums are $2 a year.
Sunny Ntayomba, an editorial writer for The New Times, a newspaper based in the capital, Kigali, is aware of the paradox: his nation, one of the world’s poorest, insures more of its citizens than the world’s richest does.
He met an American college student passing through last year, and found it “absurd, ridiculous, that I have health insurance and she didn’t,” he said, adding: “And if she got sick, her parents might go bankrupt. The saddest thing was the way she shrugged her shoulders and just hoped not to fall sick.”
I don’t see anything absurd here, but I do see something remarkable. Rwanda is so poor, its per capita income is about 1 percent that of the United States ($370 vs. $39,000). Its health care sector is an international charity case: “total health expenditures in Rwanda come to about $307 million a year, and about 53 percent of that comes from foreign donors, the 
largest of which is the United States.” That’s roughly $32 per person per year, which doesn’t buy much. Dialysis is “generally unavailable.” As are many treatments for cancer, strokes, and heart attacks, making those ailments “death sentences” more often than in advanced nations. Life expectancy at birth is 58 years, compared to 78 years in the United States. Rwandan children are 15 times more likely to die before their first birthday (7 vs. 107 deaths per 1,000 live births) and 25 times more likely to die before turning five (8 vs. 196 deaths per 1,000 live births) than U.S.-born children. (If you want to meet some Rwandan kids struggling to make it to age 5, read my friend’s blog, Life of a Thousand Hills.) And yet, the saddest thing is a healthy-but-uninsured American college student.
Health Summit: A Public Co-Option?
Still doubt that the Church of Universal Coverage is a bona fide religion? Consider:
- The American people have been solidly against the Democrats’ universal-coverage plan since July 2009.
- Roughly 60 percent of the public wants Congress to scrap that legislation and start over.
- President Obama will nevertheless use that legislation as the starting point for negotiations with Republicans at next week’s health care summit.
Mmmm, that’s good fervor.
Republican summiteers shouldn’t spend too much time discussing their own ideas — which aren’t going anywhere, and really aren’t that great anyway — lest they unwittingly aid Democrats in changing the below-illustrated narrative. They should instead focus like a laser beam on the dangers of the Democrats’ legislation, and how dangerously close it is to becoming law.
Then they can all return to the drawing board and come back with better ideas.
Yglesias, Defending Klein’s Slander of Lieberman
Blogger Matthew Yglesias has a response to my post on Ezra Klein’s slander that Sen. Joe Lieberman (I-CT) is okay with the mass murder (or the mass negligent homicide) of hundreds of thousands of uninsured Americans.
Yglesias claims that only one of the three studies I cited speaks to what he claims is the central point: the Institute of Medicine’s estimate of how many Americans die each year because they lack health insurance. Yglesias is incorrect. The central point/threshold question is whether giving the uninsured health insurance will save lives. All three studies speak to that point, and all three all cast doubt on the intuitively appealing idea that giving uninsured people health insurance ipso facto saves lives.
To rebut the one study that Yglesias believes to be on point (Kronick), he offers two others. Yet all studies are not created equal. Kronick, Finkelstein/McKnight, and Levy/Meltzer represent the most reliable work that has been done on the relationship between health insurance and health. If I am wrong about that, I hope that one of those authors or another expert in the field will correct me.
But if I am right, it means that Yglesias and Klein are slandering Joe Lieberman and millions of others based on their (Yglesias’ and Klein’s) limited and distorted understanding of the world. (And even if I’m wrong, the Washington Post‘s Charles Lane explains why Klein’s slander is still wrong.)
Then again, considering that Yglesias also has another post suggesting that Lieberman and House Minority Whip Eric Cantor (R-Va.) are “dumb” Jews free-riding on the intelligence of other Jews, I’m not sure that the Church of Universal Coverage is open to persuasion right now.
Universal Coverage Means ‘Willing to Let You Die Sooner’
I cannot disagree with Uwe Reinhardt’s response to my previous post at National Journal‘s Health Care Experts blog. But his response bears clarification and emphasis.
Improving “population health” generally means “helping people live longer.”
To paraphrase, Reinhardt then writes:
If helping people live longer were our objective in health reform, we could do better than universal coverage. But health reform is not (solely or primarily) about helping people live longer. It is (also or primarily) about other things, like relieving the anxiety of the uninsured.
I applaud Reinhardt for acknowledging a reality that most advocates of universal coverage avoid: that universal coverage is not solely or primarily about improving health.
Will Reinhardt go further and acknowledge that, since universal coverage is largely about some other X-factor(s), that necessarily means that advocates of universal coverage are willing to let some people die sooner in order to serve that X-factor?
(Cross-posted at National Journal‘s Health Care Experts blog.)
Why the Democrats’ Health Care Overhaul May Die
The problem that Democrats have faced from Day One is finally coming to a head.
The Left and the health care industry both want universal health insurance coverage. The industry, because universal coverage means massive new government subsidies. The Left, because that’s their religion.
But universal coverage is so expensive that Congress can’t get there without taxing Democrats.
- Sen. Jay Rockefeller (D-WV) is the biggest opponent of Sen. Max Baucus’ (D-MT) tax on expensive health plans because that tax would hit West Virginia coal miners.
- Unions vigorously oppose that tax because it would hit their members.
- Moderate Democrats in the House oppose Rep. Charlie Rangel’s (D-NY) supposed “millionaires surtax” because they know it would hit small businesses in their districts.
And on and on…
But if congressional leaders pare back those taxes, they lose the support of the health care industry, which wants its subsidies.
- That’s why the health insurance lobby funded this PriceWaterhouseCoopers study saying that premiums would rise under the Baucus bill: the $500 billion bailout they would receive isn’t enough. They also want – they demand – steep taxes on Americans who don’t buy their products.
- The drug companies, the hospitals, and the physician groups are likewise demanding big subsidies, and will run ads to kill the whole effort if those subsidies aren’t big enough.
As always, health economist Uwe Reinhardt put it colorfully:
It’s no different from Iraq with all the different tribes…‘How does it affect the money flow to my interest group?’ They are all sitting in the woods with their machine guns, waiting to shoot.
Once the shooting starts, industry opposition will sway even Democratic members, because there are physicians and hospitals and employers and insurance-industry employees in every state and congressional district.
Can President Obama and the congressional leadership satisfy both groups? My guess is, probably not, and this misguided effort at “reform” will therefore die. Again.
The Price of Universal Coverage Just Went Up
Since at least February, President Obama and other elders of the Church of Universal Coverage have labored to create the impression that universal coverage is inevitable, because a sense of inevitability reduces its cost. If interest groups think this train is leaving the station, they are less likely to stand in its way. Lobbyists are more likely to cut whatever deal they can if their clients believe, “It could have been much worse.” That’s why Obama has demanded haste: the longer the process, the harder it is to maintain a sense of inevitability.
Here’s a sampling of today’s health care headlines from the non-partisan Bulletin News, which summarizes news media coverage:
- Senate, Obama Back Off Healthcare Reform August Deadline.
- Obama Rakes In Cash For DNC, Criticizes Media Coverage Of Healthcare Debate.
- Obama’s Performance At Wednesday’s Press Conference Comes Under Fire.
- President’s Media Strategy Raises Eyebrows.
- House Democrats Consider Sidestepping Committee.
- Democratic Caucus Holds “Contentious” Meeting.
- Black Caucus Blasts Blue Dogs; AARP, Unions Also Criticize Group.
- Freshmen Senators Ask Baucus To Hold Costs Down, Praise His Efforts.
- More Criticism Of Obama.
Now that reform seems less inevitable, interest groups will be less likely to settle for a bad deal. Instead, they will be more likely to demand higher payoffs than before, because their clients believe the expected cost of alienating Church elders has moved away from “getting punished” and toward “the status quo ante.”
So, good luck paying for this thing.
A Better Way to Reform Health Care
From my oped in today’s Investor’s Business Daily:
As it turns out, “universal coverage” may not be so inevitable after all. Much to the chagrin (and apparent surprise) of President Obama and congressional Democrats, squabbling has erupted in earnest over who will spring for the exorbitant cost.
Fortunately, Obama has an exit strategy: “If there is a way of getting this done where we’re driving down costs and people are getting health insurance at an affordable rate, and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I’d be happy to do it that way.”
Well, there is a way: Let individuals control their health care dollars, and free them to choose from a wide variety of health plans and providers. If Congress takes those steps, innovation and market competition will make health care better, more affordable, and more secure.
Howard Baker and Universal Coverage
Add former Senate Majority Leader Howard Baker (R-TN) to the Church of Universal Coverage faithful:
Health care reform and universal coverage is [sic] indeed something [sic] whose time has [sic] come.
Baker joined fellow former Senate Majority Leaders Tom Daschle (D-SD) and Bob Dole (R-KS) to introduce a health care reform package. Daschle is already a high priest in The Church. For backing this proposal, Dole probably is too, but I don’t have any juicy quotes handy.
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