Kaus Grouse
The central plank in pundit Mickey Kaus's philosophy is social equality. We may not be able to stop income inequality (at least Kaus admits this--stopping it is high on the agenda of much of the left) but we should at least know we're all equal.
That's why Kaus is worried about Obamacare. (That's why?)
Without national service, it’s not easy to come up with new institutions that might help reconnect a nation being slowly pulled apart along class lines. Health care is probably the biggest candidate left. If rich and poor use the same doctors and hospitals, wait in the same waiting rooms, etc., it will be harder for some people to think they are better than anyone else–even if some leave by bus and others in Porsches. That’s the theory, anyway.
If you entertain this theory, as I do, Obamacare is a troubling solution to the health care problem. Yes, it more or less insures everyone, but at the price of assigning people to different programs based on their income. If you are upper middle class and uninsured, you can buy insurance on the Obamacare “exchanges.” If you are non-upper middle class (under 400% of the poverty line–about $90,000 for a family of four) your purchase will be subsidized, even heavily subsidized. But if you are poor–less than 100% of poverty–you can’t get a subsidy through the Affordable Care Act. You will probably be shunted into a different system, Medicaid, which many consider inferior.
I think social equality is a great thing about America, but I believe it's based on attitude more than anything else. We're all peers in this country. There are people richer than I am, but I don't think they're better than I am. In the other direction, if I meet someone making a low (or no) wage, I don't think I'm that person's social better.
We take this in with our mother's milk. I'm not saying there are no class differences, but I don't think it compares to long-ingrained systems in other countries. (One of the reasons I support small government is to avoid creating a ruling class that feels it deserves its perks as it tells everyone else how to live.)
But trying to make sure everyone gets essentially the same medical care? Sounds dumb. I accept that people with more money can buy a bigger house or a nicer car or a better vacation. That's how it goes. If they want to get extra care above and beyond what's normally available, that's also how it goes.
I'm not talking about lousy care for others, or for the poor. I can understand a system where we work to ensure an acceptable amount of medical care for everyone, but if you want all care to be exactly equal, the most likely outcome (if you manage to pull it off--which you probably can't) is to pull down the quality of care for the well-off, not raise the quality of care for others (unless perhaps you're willing to take away an awful lot of other things).
It's a good incentive for hard work and innovation if people are rewarded for making more money. And if the rich can pay extra for certain types of care, it will help spur on research that will eventually be available to all--it works in other parts of the economy, and as long as we have market forces in the medical field, it'll happen there. In the long run, if you force equality on a system, it'll likely guarantee everyone gets worse care than they'd get otherwise.
posted by LAGuy @ 12:03 AM
14 Comments:
Lets not forget that different types of healthcare for different classes (sorry) of people also aids innovation. More resources clearly leads to innovation at the top of the chain, but making do for large numbers with less also leads to innovation. Not a reason clearly to deny any one quality care (whenever everyone agrees what that means) but just a happy accident of a non-uniform system.
Let's not forget that because health care is not subject to market forces, the ruling class is becoming the health care profession. http://www.time.com/time/magazine/article/0,9171,2136864,00.html
"Begger thy neighbor" is a poor basis for any system of government. I wonder if during the depression the poor, being a majority of the population by some standards, felt better about it because they were part of a majority?
I think envy is a very destructive sentiment, suggesting that tearing down someone else is as good as building oneself up. But envy may be the inevitable result in a media saturated society where lifestyles are constantly compared to the rich and famous.
Anon 2, you'll have to make the argument yourself. Time's partisan take doesn't do the job for you.
I was going to write a bit about how our hybrid system has some odd outcomes, but anyone who can't see how America has helped spur medical innovation just isn't trying.
Mickey Kaus is I think being paid to personify a liberal straw man
Kaus is on a conservative-leaning website because he's a Democrat who's willing to be heterodox. We should have more like him.
You should if you're on the other side.
Kaus is a rare non-straw man liberal. All the other liberals have the same mindless talking points--they're so predictable, and predictably wrong, that there's barely a reason for them to open their mouths. Kaus reminds you that liberals aren't all dogmatic and mindless, and comes from a tradition where progress could be made through both compromise and thinking things through.
Yeah, Kaus is great, and you don't get more conservative than me.
On the other hand, I about had a stroke today when I saw Leonard Pitts wrote that the the NYC soda ban was liberalism run amok. Made a nice Avengers allusion re a Dr. Doom, I think it was.
Who said anything about innovation? Aren't you just changing the argument to make yourself look right? Point was, medicine today is not subject to market forces, the article clearly shows how hospital charges are arbitrary and outrageous -- something I've seen from inside the medical industry and as a consumer. Obamacare is not the problem. It may not be the solution, but the out of control medical-pharmaceutical industry is the problem. Obamacare -- and just calling it that belies as much bias as the Time Magazine article -- may be a failed solution. At least Obama is recognizing the problem, perhaps by listening to the thousands who have been bankrupted by a serious illness or the businesses who can't keep their promises to their employees for health care. (Perhaps the bigger problem is that businesses made those promises at all.) Hopefully, recognizing the problem will get it on the agenda and eventually we will have a solution. (anon2)
I said something about innovation, and one-size-fits-all fights against that.
There are a lot of things wrong with our medical care system and I've criticized it in the past, but I can also point to how what we've got here, for all its imperfections, has been leading the way for years in innovation. My first and main complaint about nationalizing our health care (and for all its Rube Goldberg shape, that's what Obamacare is about) has always been about how it could depress innovation. The libertarian argument for the betterment of society (which so many seem to miss) is about the big picture--allowing people enough freedom and the ability to enjoy the fruits of their labor will in the long run create a better world for all. Obamacare, if anything, moves us further away from that.
I don't have time here to get into the lies about so-called medical bankruptcies, or businesses not being able to cover their employees health care (before Obamacare or due to Obamacare) but all that stuff is secondary to the big picture. An horrendous non-solution like Obamacare will not only make things worse, but make it impossible to have actual reform.
Well, isn't that convenient. The people who disagree with you are lying. There are just as many lies on the medical establishment side, where $500K salaried doctors boo-hoo about not being able to pay student loans and pharmaceutical companies claim the $20K per dose covers the drug development costs when the drug mostly came from government sponsored academic research. And maybe a little from people buying pink ribbons.
I don't miss the libertarian argument and I think for healthcare it is misguided. The U.S. medical establishment has shown their greed and, from what I've seen, shifted from betterment of people to making money. U.S. health outcomes have been dropping and I see decisions made often that put money over health.
But I will guess you'll accuse the data on outcomes to be lies, too. We fundamentally disagree. I think the libertarian position here is based on a medical industry that maybe existed fifty years ago and maybe never at all. And it simplifies the vision to be of little value.
The only lie I'm referring to is the lie about the percentage of bankruptcies caused by medical bills. I've discussed and documented it in the past and I don't want to go into it again.
As far as doctors and others getting paid too much, that's a judgment call, but cutting their salaries (how--by government fiat?) isn't likely to create a better medical system.
Calling others greedy isn't helpful. It's not an argument, just name-calling. As far as medical outcomes, I'd rather get medical care today than twenty years ago, or ten years ago, or even five years ago, and that's what really counts--it's easy to lose sight of that big picture when you look at other, less important data. There are numerous flaws in the system (much of it due to excessive government intervention), which, as noted, I've discussed elsewhere. Furthermore, there will always be bad outcomes no matter what system we adopt, but the big picture is still what counts most. (Additionally, we shouldn't confuse outcomes based on what doctors and others professionals do and outcomes based on other things such as lifestyles.)
By the way, if it isn't clear, I'm in favor of massive reform of our health care system. That's yet another reason to oppose Obamacare, which makes reform so much harder.
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