Today I attended a debate about the nationalization of healthcare. The panelists were Doug Bandow, senior fellow at the Cato Institute; Neville Cox, director of post graduate teaching and learning at Trinity College Dublin School of Law; and David P. Fidler, Professor of Law at Indiana University Maurer School of Law.
Surprisingly, the panelists agreed on many issues. All agreed that having health insurance tied to employment was foolish; that the present U.S. healthcare system was unsustainable and that radical changes were necessary to prevent serious negative consequences; that efforts to resolve the problems with healthcare at a national level will continue to be undermined by the substitution of political maneuverings for reasoned solutions; that there is no successful system of nationalized healthcare in the world; that the American people has an obligation to care for the poor and needy in its society; and that all healthcare systems demand uncomfortable tradeoffs.
Since I didn’t take careful notes and since my memory isn’t good enough to write a play-by-play account of the debate, I will simply summarize what I understood the panelist’s positions to be.
Professor Cox argued that the British healthcare system where the government provided health insurance was a good model, and cited statistics which place the United States at the bottom of industrialized nations in healthcare quality. He thought that the “public option” element of President Obama’s healthcare plan was essential to ensure that individuals with chronic healthcare problems requiring expensive care had access to insurance. He argued that healthcare was an area in which individual autonomy would have to yield to social need. He recognized that this would entail the rationing of healthcare and that government would have to make the rationing decisions—especially in areas where the likelihood of the patient surviving was low and the treatment costs were high. Overall he supported President Obama’s plan and hoped that it would succeed.
Professor Fidler began by trying to explain why the recent efforts to reform healthcare had failed. He argued that the public simply doesn’t believe President Obama’s claims that the healthcare bill would not require deficit spending. Government efforts to provide services in the past had always gone over budget—usually dramatically over, so the public simply isn’t willing to believe that healthcare would be any different. He almost scoffed at the idea that President Obama would be able to squeeze any real money out of the Medicare and Medicaid programs. Evidence of this is the fact that Congress passed a benefit cut to Medicare and Medicaid in 2002, but for the past 7 years they have postponed the bill’s effective date in response to political pressure. Professor Fidler also speculated that the public was genuinely afraid of radical change to their health insurance plans, and that the public did not believe Obama’s assurances that those who were happy with their current health insurance would see no change in the system. He also questioned, if healthcare were truly such a high priority for the country, then why would the Obama administration be unwilling to use deficit spending to fund it? Nevertheless, he conceded that the current health insurance system was badly broken.
Mr. Bandow of the Cato Institute was clearly used to debates of this kind. He had numerous facts and concrete examples at his disposal to illuminate his arguments. He began by clarifying the statistic that Professor Cox cited about the quality of United States healthcare. He noted that if accidents and violent crimes were eliminated from the statistical calculations, then the United States healthcare quality would rank in the middle range of scores from industrialized nations. Mr. Bandow next argued that the problems with United States health insurance were caused by perverse incentives: the patient is not directly paying the costs, and healthcare providers benefit from high costs. In other words, of the two parties who make decisions about what treatment a patient should receive, one doesn’t care how much it costs because the insurance company is paying for it, and the other wants the costs to be high because high costs yield profits. Consequently, there is very little incentive to reasonably evaluate whether a treatment is necessary or even beneficial before paying for it. This system drives up costs and wastes resources. Real reform, Mr. Bandow argued, will not simply provide more healthcare services to more people; United States citizens already consume much more healthcare on average than the citizens of any other nation. Real reform would place incentives toward efficiency on the individuals who were making the decisions about what treatment was necessary and what treatment was not. This would eliminate waste and reduce costs. This would also allow individuals rather than government bureaucrats to make the hard decisions about issues like end of life care and treatments with a low likelihood of success.
So there you have it. Three perspectives on healthcare reform. If any of the positions above seem unclear, please post a comment and I will try to clarify what the panelist meant.
Without going into too much depth, I just want to point out that except for the unanimous-but-indistinct affirmations that the United States has an obligation to care for the needy, none of the panelists argued from a basis of principles. Nothing was said about whether compelling individuals to purchase health insurance would violate important principles of individual autonomy. Nothing was said about whether granting government power to make decisions about medical care for individuals would violate important principles of individual liberty. Nothing was said about whether taxing the many to support the few would violate property rights. Are we too far down the rabbit hole to worry about such things anymore? Instead the panelists relied on consequentialist/utilitarian arguments grounded in economic theories about which plan would maximize healthcare overall.