Baseball Crank
Covering the Front and Back Pages of the Newspaper
August 13, 2008
POLITICS: Rush Limbaugh on health care

Posted by Ricky West



The libertarian in me is horrified by the notion that the government may
mandate that I take part in a federal health care plan.  Instead of droning
on endlessly, the Godfather of radio laid things out perfectly a few months
back:



A friend of mine in a state
on the East Coast sent me a note.  This is yesterday: "I heard a rather
liberal GOP political consultant here in Raleigh say today that health care
is too complicated to be a deciding issue in the elections; it can't be
summarized in 30 seconds, it's just too hard."  So we're not even supposed
to talk about it, don't even go there.  Liberal Republican consultants,
don't even talk about health care, it's a losing issue, just as you are
saying, Tony.  I don't accept that it's a losing issue, and I don't accept
that we have to accept things about it, like it's a right or it is too
complicated.  



In less than 30 seconds, I can explain health care in a nutshell.  No
employer, no insurance company, no politician or government bureaucrat knows
better than you about your family's health needs.  You should have the right
to purchase health care and health insurance as you see fit without
governmental restrictions or penalties, and you should not be of the mind
that your neighbors have to buy it for you.
  Less than 30 seconds
I've just explained the concept of fixing health care.


[]


What we also have in this
country are some people who don't want to use their own assets to pay for
their own health care.  They want someone else to do it.  And that brings in
a very happy and compliant Democrat Party.  It is a matter of individual
priorities.  Let me say it to you as Mr. Buckley might have said it.  Moral
obligations, should one choose to assume moral obligations, are actually
higher on the list of things than rights.  That's why we set up systems to
take care of the indigent, because we are a moral people.  It is why we have
Medicare; it is why we have Medicaid; it is why we have S-CHIP.  At least
it's why we started them.  It's why good people support them.  We can get
into an argument here of whether these programs are more of the same liberal
drivel to create as many dependents as possible, but I think we are a
compassionate country, and we are a country that understands our moral
obligations to people who can't provide for themselves because of certain
things, and those people nobody will argue with, being taken care of and
helped.  That is precisely why we set up systems to take care of the
indigent.  It is why we take care of our neighbors.  It is why we have our
churches engage in the various community actions that they do and, not to
mention, there's all kinds of other community organizations that exist for
the express purpose of bringing things to poor, indigent people that they
don't have and can't have on their own.  



This is a country of high moral obligation, and we meet those moral
obligations at all times.  That is why, because we have such a moral
obligation, and because we are such a compassionate people, and because we
are such a generous people, this is why we try to lower costs and increase
competition so that more people can be taken care of well, so that people
are not left to fall through the cracks.  Now, this doesn't mean that any of
this is a right.  It is our moral obligation as a society that has us take
care of people who otherwise could not afford this.  But what has
happened is that people who very well could afford it, just as they could
afford a plasma TV or a car or what have you, can afford health care and
choose not to, they choose in fact for others, their neighbors, fellow
citizens, to pay for it, precisely because they have been led to believe
that it is their right to have health care.  And I would submit to you that
the whole notion of having your neighbor pay for what your responsibilities
are can be very addictive, once it starts.
 



Emphasis mine.

Posted by Ricky West at 12:42 PM | Politics 2008 | Comments (84) | TrackBack (0)
Comments

This is ridiculous. If you are relying on Rush Limbaugh for your analysis on health care or any other issue, then something is very seriously wrong with you.

Posted by: steve at August 13, 2008 2:03 PM

Steve,

Why?

Posted by: lee at August 13, 2008 2:29 PM

Why? Google Rush's name and you will find hundreds of examples of factual errors and outrageous opinions on every imaginable topic. I cannot imagine any greater blowhard than Rush. I am convinced he makes it up while he goes along. Plus, I don't trust someone who was popping dozens Oxycontin pills a day, and who almost certainly when he was on the air.

The health care issue is classic. Read closely what was printed here and you'll see that Rush is blaming poor people for not being able to afford health care. Ridiculous.

Posted by: steve at August 13, 2008 2:48 PM

It states very clearly that we - this country - take care of the destitute and those who cannot take care of themselves. The subject at hand is the hue & cry from those who CAN provide but want someone else to do it for them, and how dangerous that cradle-to-grave mentality can be.

I even went out of my way to bold & italicize it.

Perhaps googling Rush's name brings up countless examples of people misrepresenting - sometimes intentionally - what he actually said?

Posted by: RW at August 13, 2008 3:01 PM

Poor people get health care all the time. Go to any ER and look around.

We've almost become too advanced in the medical field. It has become normal for people to expect top-flight health care. People feel like they have a right to top-flight health care. Liberals want everyone to get top-flight health care. Is there any other commodity or service that is like that?

Like in all other areas of life, you should get what you can afford. People should buy their own health care as individuals and families, not have it through employers. That would increase competition, give people and businesses more personal and economic freedom, and would lower the cost of health care.

Posted by: per14 at August 13, 2008 3:17 PM

A couple of points:

1) I don't know if Rush was talking about Obama's plan, but Obama's health care plan, as far as I could tell from his website, does not make it mandatory for people to purchase gov't insurance. This was one way it was different from Hillary's.

2) Rush oversimplifies the debate, which is why I rarely pay any attention to him. Yes, I'm very sure that some people who can afford health care are not purchasing it. The problem is, those people also wind up getting -free- health care anyway when they eventually wind up in the hospital. This raises everyone's premiums. To an extent (and we can argue ad nauseum how much of that extent), we end up paying for their health care anyhow. What does Rush have to say about those same people free-riding on everyone else's health care premiums?

3) I'm willing to -consider- some gov't involvement in health care, but it's going to take a very good plan to convince me. We have to be able to afford it, and we have to keep the market involved to some extent.

Posted by: MVH at August 13, 2008 3:21 PM

Steve:

Critique the argument, not the man. You don't "trust" him? He's not asking you to trust him. He's making an argument.

I think Rush is kind of a blowhard, and I almost never listen to his show. But as you've demonstrated, it's tough to argue with what he's saying. He's blaming the middle class and, in some cases, the wealthy, for prioritizing other spending over health care and then whining that they can't afford it and someone else should pick up the tab.

Posted by: Joel B. at August 13, 2008 3:26 PM

MVH,
He wasn't discussing Obama. This took place several months ago and the context, funnily enough when considering Steve's comments, was letting some Republicans "have it" for their reticence to discuss certain issues because they're tough to campaign against. He went off on a rant about health care, and I logged it into long-term memory because it was pretty much how I felt.

All this stuff about the 'poor' not getting health care is a straw man since no one outside big-L libertarians are saying that we shouldn't have taxpayers help out those who can't. Again, the important word is "can't".

Pimping my own site, I know, but there are some states that remove the issue of poor kids being covered. Personally, I've always raised my eyebrows at people on television who went on-and-on about "X million people don't have health care" while contending that any optimal solution is one in which THEY are also on the sign-up sheet.

I don't mind a poor kid being on Medicaid. An elderly person has EARNED their medicare. I mind very much when someone in the middle-class wants me to pay their bills so they can go from a PS3 to a wii. When did it become en vogue to sit in the cart and allow others to pull the load? And, forget saying 'thanks', even that is never enough.

Posted by: RW at August 13, 2008 3:51 PM

RW,

What about my point #2, doesn't it bother you that you are paying for them anyway? Because they choose not to have health insurance, you are paying more for yours.

By the way, I have an empirical question. What percentage of the uninsureds are really comprised by those who can "afford" it? Is there any data, or is Rush just pulling up convenient hypotheticals?

Posted by: MVH at August 13, 2008 4:19 PM

Is there any data, or is Rush just pulling up convenient hypotheticals?

There is no data in this exercise. It's a big picture question re: personal responsibility. What one may regard as "quality" health care, may not align with anothers definition. Our moral obligation as a nation, compels us to "help" the indigent, however, just what that "help" should look like is in the eye of the beholder...and the source of many battles on Capitol Hill.

Posted by: Phils57 at August 13, 2008 5:04 PM

Rush Limbaugh? Seriously? Who's next? Ann Coulter?

Well at least now, knowing the source of your information, we all know how you could be so wrong about so many things.

Posted by: Magrooder at August 13, 2008 5:44 PM

Some historical context is needed for a discussion about who funds healthcare. Employers started doing it during WWII because there were wage and price controls which prevented raising salaries in order to attract labor. Labor was short because everyone was in military service, so manufacturers were relying on 4F's, women and the elderly. There just wasn't enough to go around, so they had to find some way to compete for workers, thus non-salary benefits such as healthcare became standard.

We all are aware that healthcare was not then what it has become. You got cancer, too bad, you died. There were no heart lung transplants, no CAT scans, and the point I'm making was that healthcare was very cheap compared to what it is now. So we as a nation became used to getting another entity to pay for healthcare, but if you lost your job, it wasn't the big deal it is today because the expectations were very low.

Obviously, the costs have risen tremendously, and we still have the expectation that another entity will pay for healthcare (or at least the major part of it).

Rush's original point that it is not difficult to explain a wonky subject in less than 30 seconds may not be the best way to approach the issue, but overall, when we let other entities become liable for paying the bills, we as individuals tend to not act responsibly in terms of shopping for the best deal the way we do for that all important flat screen TV. This is not even getting into the more important issue of trying to take care of your health to avoid maladies that are truly avoidable.

As a taxpayer who currently helps to fund medicare, medicaid, schip and whatever else is out there, I get royally torqued off over a theoretically poor person who does not spend money on insurance, but will buy big ticket consumer items (for example, I have two TV sets, one a 19 inch from 1989 and the other a 27 inch from 1995). This is not to mention all of the other purchases they may be making to satisfy the need for STUFF. They're also probably not doing a thing to fund retirement either, but that's an argument saved for a Social Security blog.

My question to one and all is do you think the typical uninsured jerk who has better consumer goods than I do would self insure without government coercion (assuming his employer did not offer it in the first place)? There's got to be some basic policies around that cover the big ticket heart attacks, chemotherapy, MRI's and whatnot, while the buyer pays a high deductible. In any event, I'd prefer that rather than an ever enlarging bureaucracy that gets fleeced by fraudulent claims etc.

And please get over dismissing an argument just because Rush Limbaugh made it. Try to engage the points and come up with something more coherent if you can, but screaming Oxycontin tells me that you are not really able to do intellectual combat on this issue.

Posted by: NRA Life Member at August 13, 2008 7:03 PM

Is there any data, or is Rush just pulling up convenient hypotheticals?

It's opinion.

Well at least now, knowing the source of your information, we all know how you could be so wrong about so many things.

Funny that you mentioned Queen Ann, she coined the term "with liberals, history began yesterday", which begs the question: what happened to the high ground & the ad hominem approach? :)

What about my point #2, doesn't it bother you that you are paying for them anyway? Because they choose not to have health insurance, you are paying more for yours.

Yes, sure. Since the gov't has no qualms about expecting everyone, including the lower middle class, to do such things as pay their taxes, pay their traffic fines and maintain their utilities, taking the same approach to paying their medical bills shouldn't be such a stretch. Trust me, they'll lock you up if you don't pay your fines. Well, is owing the gov't more sacred than owing a private entity?

what percentage of the uninsureds are really comprised by those who can "afford" it? Is there any data, or is Rush just pulling up convenient hypotheticals?

I'm sure the data is out there, but it's really an overall statement about health care & funding, in general. The context was it as a viable political issue for Republicans (iffy) and the fact that letting the notion that gov't control as the best solution is wrong.

Apparently, it's quite radical to say "for those of you who aren't destitute, hey, how's about you pay your bills?"

And please get over dismissing an argument just because Rush Limbaugh made it.

In my experience, most people who try to do that haven't heard him & instead rely on their favorite source of Rush-hate. It was illustrated earlier in this very thread, actually. IIRC, yesterday I unloaded on Andrew "Kerry is more conservative than Bush" Sullivan, which is really shooting fish in a barrel. But, that aside, I don't find it out of bounds to question the credibility of a person taking a stance. In this case, challenging the communication skills of someone who just scored a $400 million contract to communicate his opinion is quite a hurdle to cross. Seems as though the free market feels he's quite credible, in fact.

Which could be why the Dems are seeking to put a dent in his effectiveness via government mandate.

Posted by: RW at August 13, 2008 7:53 PM

Well, if you really want to have the basis of an argument be based on the opinions of a drug addict who needs major connections to stay out of jail.....

Anyway, the real problem is that health care TODAY is not at all relevant to what we had or expected even 20 years ago when then we were all clamoring that health care was too expensive. Of course, then everyone complained that the doctors made too much. Well, I didn't, to me a happy doctor was a good thing. But the needs, the drugs, the diagnostics, and dammit, the lawyers, have all made so many different demands that it's almost impossible to say, "Your family gets to decide," because unless your family name is Limbaugh, or Bush, or Kennedy or McCain, well, it's not just a matter of who can afford what. Except managed care by the government won't work. Managed care in the private sector doesn't, why expect a public one to work.

I have the solution: all doctors in the world refuse to care for the Senators, Representatives, the President and all, and their families. Watch a solution present itself. Suddenly, everything gets paid for!!!

Limbaugh was his usual glib self, not really making a point, but really showing how out of touch he can be.

Posted by: Daryl Rosenblatt at August 13, 2008 8:36 PM

Well, if you really want to have the basis of an argument be based on the opinions of a drug addict who needs major connections to stay out of jail.....

Anyway, the real problem is that health care TODAY is not at all relevant to what we had or expected even 20 years ago when then we were all clamoring that health care was too expensive. Of course, then everyone complained that the doctors made too much. Well, I didn't, to me a happy doctor was a good thing. But the needs, the drugs, the diagnostics, and dammit, the lawyers, have all made so many different demands that it's almost impossible to say, "Your family gets to decide," because unless your family name is Limbaugh, or Bush, or Kennedy or McCain, well, it's not just a matter of who can afford what. Except managed care by the government won't work. Managed care in the private sector doesn't, why expect a public one to work.

I have the solution: all doctors in the world refuse to care for the Senators, Representatives, the President and all, and their families. Watch a solution present itself. Suddenly, everything gets paid for!!!

Limbaugh was his usual glib self, not really making a point, but really showing how out of touch he can be.

Posted by: Daryl Rosenblatt at August 13, 2008 8:36 PM

NRA first. If you want historical context, it helps to get the history right. Employer-funded health care is so widespread because unions sought it in collective bargaining agreements. If you are "torqued off" about the waste of tax funds, how about the waste of billions on a trumped up war in Iraq? (among other corproate welfare programs from the Bushies). Finally, I thought the "welfare queen" steroetpyes died wiht Reagan, but I guess not.

Ricky. I've listened to Rush a few times and have heard excerpts on TV. Let's just say I wasn't impressed by his understanding of the issues, his care for factual acuracy or his ability to understand more complicated issues. As for the substance of his "ideas," it brings to mind the old saying that "A rich man has just as much right to sleep under a bridge as a poor man."

Posted by: Magrooder at August 13, 2008 9:37 PM

" If you are "torqued off" about the
waste of tax funds, how about the waste of billions on a trumped up war in Iraq?"

You know, that's a fallback for almost any argument.
Ted Kennedy mowed down a family of five with an uzi? Well, Bush & Cheney killed tens of thousands in the war for oil! Obama was found to really be an illegal alien who has never registered for a social security card & has never paid taxes? Well, Bush lied us into war for oil and they've killed children in the process.

You're against the war; great. Plausible position. So's the opposite, but, fine, they're legitimate sides.

Can we leave that to war discussions, though, instead of crutches? Otherwise, we're all just screaming at what we perceive are the demons in those we're debating.

Posted by: RW at August 13, 2008 10:06 PM

My whole point is that this really should be an empirical question and not a big picture/philosophical question. We are already paying for the uninsured through higher premiums - regardless of whether they are poor or not - because hospitals are obligated to treat them. We are already paying for non-portable health insurance in the form of huge administrative expenses from people switching back and forth and administering COBRA.

The question should be: under what plan do you pay more, a universal coverage plan (with free market alternatives) or the current system? I don't make an assumption either way at this point because I don't know the figures and it will vary with the type of universal coverage proposed.


Posted by: MVH at August 13, 2008 10:20 PM

Gee, all I asked was "Why?" and see what got started! ;-)

Arguing about the cost of health care is one issue; how about quality of care? The horror stories out of Canada and England don't make me want to try their system.

Also when has the governement ever run a domestic program well? Not a good track record.

Some comments about Rush. I hear alot of negative stuff about him, but one day I actually listened to him. He does an effective job of providing a conservative voice. He is not a newsman; he gives his opinion. Most times he has strong facts to back it up; sometimes he does not. At least he is proud of the US and supports the troops.

I contrast him with Chris Matthews who presents himself as a newsman, but really is just spouting off his opinions. Matthews track record on getting it factually right is not very good.

Posted by: lee at August 14, 2008 7:42 AM

If a government-controlled universal health care system is so much "worse" than the system we have now, why do countries with socialized medicine have higher standards of living and longer lifespans than the United States?

Posted by: Dill at August 14, 2008 8:10 AM

Huh?
Higher standards of living than the richest nation in the history of civilization? I'd like to see this list & how they're handling the hordes of illegal immigrants pouring over their borders in order to take advantage of the nirvana that is their system.

Posted by: RW at August 14, 2008 8:43 AM

"Arguing about the cost of health care is one issue; how about quality of care? The horror stories out of Canada and England don't make me want to try their system."

Well, wait a minute, we're talking about universal insurance coverage, not the government actually providing the health care.

Posted by: MVH at August 14, 2008 8:47 AM

"Well, wait a minute, we're talking about universal insurance coverage, not the government actually providing the health care."

Well, let's be honest, universal coverage w/o gov't management would last exactly one election cycle. You and I could write the campaign ads detailing how 'evil insurance company X is putting profits over patients' and the like. Besides, universal coverage w/o oversight would probably make costs balloon. I mean, if there's zero fallback from taking your kids to the doctor for the sniffles - at least now there's a co-pay in almost all cases - then there's little to dent the urge to go to the doctor for anything under the sun.

If you're given well water for "free" and the costs are allocated primarily to others, then you're likely to keep going to the well over and over, even if you're not all that thirsty. Or, I'd think that'd be akin to human nature.

What'd keep someone playing a pickup game of basketball who bangs their knee from demanding an MRI ("hey, they gave Kobe one the night he got hurt") just in case it was an ACL tear, when it was just a wrentched knee that would subside after the swelling went down & gave it some rest? How would that be avoided under gov't funding but not gov't managed?

[I know for a fact that some hospitals/docs stretch out the Medicare funding, simply because they can due to the iffy oversight]

Posted by: RW at August 14, 2008 9:15 AM

MVH,

While you are correct that there is a difference, providing coverage (ie. being the decider of what health care will be paid for, how much, and which providers will be permitted to be part of the system) will impact the providers of such care (hospitals and doctors) as to what the services and quality of coverage we will eventually receive.

Is the key issue here costs? Meaning that people can't afford to pay for medical services. Then how will government coverage lower the costs? Is the explaination is that we are not really going to lower the ACTUAL costs but subsidize the cost for people who can't afford coverage? If so, how do we decide who needs to get subsidize and who does not? How do we differentiate between people who "could" afford to buy coverage but decide to use their money another way? What if even with lower coverage costs, these same people decide to use their money for other things? Do we just give them coverage for free?

If we say that the government will be a competitor (as they are with medicare) to the private health care providers (like Blue Cross) and offer costs low enough for people to afford it by taxing all of us (those who actually pay taxes) to subsidize, then this creates a situation where private companies are competing with the government. This rarely works out well.

Rereading what Ricky posted (and Rush said), this is exactly the point.

If the issue is cost of coverage, then let's look at ways to lower the ACTUAL costs. Not by mandating the costs, but looking at the root causes of cost and do real things to lower the costs. Then people who presently can't afford it will be able to (if they want).

Lastly, I'd like to see good numbers as to how many people do not recieve critical medical treatment because they actually can't afford them and were denied treatment.

Coverage is insurance. It is a means you pay a monthly fee so that if you have larger costs in the future you will not have pay them all out of pocket. This is not the same as being refused medical treatment because you don't have the money at that exact instant.

Posted by: lee at August 14, 2008 9:38 AM

Ignorance is bliss isn't it. You tell us what you think of Rush Limbaugh and call him names but you do not listen to him on a consistent basis, or at all. You just googled his name and pulled your opinion from there and take it for fact. That just shows you hypocrisy and your ignorance, and if you have those 2 traits you're probably voting for Obama.

Posted by: Morris at August 14, 2008 9:44 AM

Actually, I have been listening to Rush for years, and I have given much thought to his opinions and the ways that he frames his arguments. I have probably listened to him more than most conservatives. I disagree with him 100 percent, and find his opinions ridiculous, but my opinion of him is based on what I have heard on the radio. I am astonished that a guy with such infantile views commands such a large audience.

Posted by: steve at August 14, 2008 9:55 AM

RW,

"I mean, if there's zero fallback from taking your kids to the doctor for the sniffles - at least now there's a co-pay in almost all cases - then there's little to dent the urge to go to the doctor for anything under the sun"

Who's saying there wouldn't be co-pays? Obama's plan, for example, requires co-pays. I don't anyone wants to provide an incentive for people to go to the doctor whenever they feel like it without a cost.

Lee:

"Lastly, I'd like to see good numbers as to how many people do not recieve critical medical treatment because they actually can't afford them and were denied treatment."

The problem is the exact opposite. Poor people -are- getting critical medical treatment when they can't afford it, and it is raising -everyone else's- premiums. And -partly- because those people can't afford regular doctor visits because they have no insurance, they wait until the problem becomes critical, which in turn requires that they get the most expensive medical treatment, which again, -we- end up paying for.

Posted by: MVH at August 14, 2008 10:04 AM

"Who's saying there wouldn't be co-pays? Obama's plan, for example, requires co-pays. I don't anyone wants to provide an incentive for people to go to the doctor whenever they feel like it without a cost."

Well, I wasn't discussing Obama's plan, just the notion of universal health insurance. Under a normal plan, you have your co-pay and then are liable for what the insurance company doesn't pay.

"I don't anyone wants to provide an incentive for people to go to the doctor whenever they feel like it without a cost."

There are plenty of people, including lawmakers, who most certainly do want a Canadian/European style scenario. Single-payer means....well, single.

Posted by: RW at August 14, 2008 10:16 AM

RW:

"There are plenty of people, including lawmakers, who most certainly do want a Canadian/European style scenario. Single-payer means....well, single."

Well, sure, but that isn't what I'm talking about, and Rush's point covered both insurance coverage and single-player plans, which I don't think should be equated.

Posted by: MVH at August 14, 2008 10:39 AM

MVH,

You wrote "The problem is the exact opposite. Poor people -are- getting critical medical treatment when they can't afford it, and it is raising -everyone else's- premiums. And -partly- because those people can't afford regular doctor visits because they have no insurance, they wait until the problem becomes critical,..."

Ok, so government sponsored health care insurance that is optional solves this how?

Posted by: Lee at August 14, 2008 11:39 AM

"Ok, so government sponsored health care insurance that is optional solves this how?"

That is one of the debates over what policy is appropriate: if you're going to have universal coverage, is optional OK or do you need to make a health care insurance mandatory?

Under Obama's plan, health care insurance is optional: you can choose the government plan or a private plan or none at all. Obama's theory is everyone would choose health care insurance if they can afford it.

Hillary's plan, if I remember correctly, would make health insurance mandatory - you have to have a plan either through the gov't or a private policy.

If memory serves, hospitals prefer a mandatory plan because of the free-rider effect. Meaning, if health insurance was optional, people could opt out of health insurance, and hospitals would still be obligated to treat them for emergency care, and those costs would be passed on to everyone else.

Posted by: MVH at August 14, 2008 12:07 PM

MVH,

I can understand WHAT is being proposed, but HOW is the problem solved?

A mandatory plan is enforced how? Automatic payroll deduction like SS and medicare? If you can't afford it (again with all of the issues around how do you determine a person can't afford it), what happens? You go to jail?

If it is optional, what do you do if the person does not subscribe? He has to pay for the service if he requests it?

None of the above options attack the root cause. It just makes us pay for others-again!

Posted by: lee at August 14, 2008 12:27 PM

"If it is optional, what do you do if the person does not subscribe?"

I don't know what's being proposed about enforcement. It's an issue, obviously. The whole health care insurance coverage issue is comparable to mandatory automobile liability insurance, which many states have. I'd look at how they enforce those.

"If it is optional, what do you do if the person does not subscribe? He has to pay for the service if he requests it?"

That's a good point, and to the extent I am willing to look at these plans, it's one of the reasons I'm not a particular fan of optional plans.

Posted by: MVH at August 14, 2008 12:44 PM

At this point, I believe that the root of the push for a single-payer system is that the insurance companies have so thoroughly pissed off everyone with their policies. You pay them every month and then when you actually want them to do what you're paying them for, they go through every possible contortion to avoid it. If the medical situation is serious enough, then their tactic is to stall until the patient dies.

I'm a registered Republican. I think that 99% of the time, capitalism is the best system. But when it comes to health care, we're in the 1% where it's not.

Posted by: Steve H at August 14, 2008 1:10 PM

You're absolutely right, Steve H. What so many who are regularly on this site don't understand is that true capitalism, just like communism, goes against human nature. Insurance companies don't want to pay your claims from the get-go, because it costs them money How's that for simplification?

Also, down here in Texas, you can't drop your pen without hitting a short Republican. I have loads of conservative friends and family members, and I don't know a single one who thinks Rush Limbaugh knows what the hell he's talking about any more often than he doesn't. Quoting him - and expecting your audience to take it for granted that he's got his facts straight - automatically makes any point circumspect. Period.

Like O'Reilly, he's in the ENTERTAINMENT business, just like Susan Sarandon and Bruce Springsteen and all those other horrible people you guys cry about all the time.

Posted by: macsonix at August 14, 2008 1:29 PM

"Actually, I have been listening to Rush for years, and I have given much thought to his opinions and the ways that he frames his arguments. I have probably listened to him more than most conservatives. I disagree with him 100 percent, and find his opinions ridiculous, but my opinion of him is based on what I have heard on the radio. I am astonished that a guy with such infantile views commands such a large audience."

Fine, Steve. If his opinion is so infantile, critique it, and leave Rush's personal failings out of it. They're entirely beside the point.

Posted by: Joel B. at August 14, 2008 1:29 PM

Macsonix:

Your argument assumes that government agencies don't face cost pressures. They do, and those cost pressures will lead them to make the same decisions that insurance companies make. Witness Oregon Health Plan participants being offered assisted suicide in lieu of chemotherapy.

http://www.registerguard.com/csp/cms/sites/dt.cms.support.viewStory.cls?cid=106873&sid=1&fid=1

If the government takes over health care, you're not solving problems, you're simply trading one set of problems for another. The fact of the matter is, high-quality health care is expensive, and someone has to pay for it. As long as people aren't paying for their own health care, they're not going to make optimal cost/benefit decisions, so someone else (insurance companies and the government) will have to make those decisions for them.

Posted by: Joel B. at August 14, 2008 1:47 PM

You want a critique of Rush? Many books have been published about his illogical arguments and made-up facts. What I recall over the years is that he consistently sides with the most powerful institutions in American society, including corporations, the military, the Executive Branch (if a Republican is in the White House). He mocked and laughed at the abuses at Abu Ghraib, and is basically telling his listeners that it's OK to be an ugly American: we can trash the environment all we want because we are Americans; we can go to war whenever we want because our motives are always pure (if a Republican starts the war); poor people are to blame for their troubles, and somehow the welfare systems is specifically intended to enslave minorities and others to be permanently dependent on the government. He also consistently makes borderline racist and sexist comments, accuses his political enemies of Nazi-like tactics and was so abusive in making fun of AIDS in the 1980's that he had to apologize for it. Nice guy, that Rush.

Posted by: Steve at August 14, 2008 3:16 PM

I'm not saying there aren't cost pressures on whichever entity is going to make health care and treatment decisions. And a very interesting article, BTW, on the Oregon situation. What I am saying is that to characterize Obama's plan, or any plan that increases govenment oversight of the American health care industry as "government-run health care" is to not only oversimplify, but also to willfully misrepresent. Not that it would weigh on Rush's conscience.

Posted by: macsonix at August 14, 2008 4:25 PM

Additionally, I would love to find out exactly who these people are who apparently have 60" plasma TVs and an Iphone and a handful of blade servers on which to play Madden '09. Are there just hordes of these folks who would burden the rest of us taxpayers (themselves included) with footing the bill for their health care needs? And who's got an answer for the guy who asked, if I may paraphrase: "what's the difference if we're paying for them anyway when they go to the emergency room and don't ever pay the bill?"

Posted by: macsonix at August 14, 2008 4:35 PM

Masconix - I think Rush heard someone say, "I'd give my right arm for a plasma TV" and assumed that person was giving up their health insurance.

All kidding aside, I'll throw in another class of people: those who can't even think about getting affordable insurance because of a preexisting condition. Unless they happen to work for a company whose insurance plan has an open enrollment period (and they stay with that company), they too will wind up in that emergency room.

Posted by: MVH at August 14, 2008 7:36 PM

It's quite fascinating that in a country where the pardoning of corporate sins can't possibly occur fast enough, in a year when the IMF calls the American subprime mortgage debacle the worst financial shock since the Great Depression, in times when wealth and global consortiums control ever-greater portions of the world economy, in an age when the real estate closest to Capital Hill is owned and lived in by former public servants who've arrived to collect on dubious efforts rendered to a grateful citizenry, we've somehow come to convince ourselves - as a nation, mind you - that some freeloading loafabout with nary a pot to piss in has figured out how to game the "system" and thereby deny the hardworking, God-fearing American middle class its due. Give me a break.

Guys like Rush would actually be funny if they weren't so pathetic.

Posted by: macsonix at August 14, 2008 8:11 PM

RV

Rush's listeners crave simplicity in a complex world. They sense things are awry in their world but they can't figure out why. So they look to Rush to simplify things like our health care crisis, foreign policy, immigration and the economy.

His blather on health care which you so cherish is a perfect example. I just checked on my company's intranet website to confirm the exact amount my health insurance costs annually -- a lot of companies now offer this information so employees will know how much they receive beyond their paycheck. I pay $7,116 and my employer pays $6,321 for a total of 13,437 plus another thousand for dental to cover me, my wife and my one child.

I suppose if I declined my health insurance and finagled a way to get my family on Mediciad, then I would fit Rush's description of a free rider (though I do not own a plasma TV).

But can you or your overinflated guru explain how the man who bagged your groceries or poured your coffee is supposed to come up with that $14 Grand? And if the grocery bagger happens to have a pre-existing condition you can double those numbers.

And if he or she waives the surrender flag and goes without health insurance, the hospital will still provide care in an emergency situation (as GWB gleefully pointed out) but it will also place a lien on everything he or she owns and turn the bill over to a debt collector.

But its a very simple problem with a simple solution..right? I think you should stick to baseball RW.

Posted by: Patrick at August 14, 2008 8:44 PM

Health care is a difficult and complex issue that is difficult to treat in the pithy style of a politician or a radio guy who talks politics.

NPR had a nice segment on France's non-socialist health care.

"Americans assume that if it's in Europe, which France is, that it's socialized medicine," he says. "The French don't consider their system socialized. In fact, they detest socialized medicine. For the French, that's the British, that's the Canadians. It's not the French system."
[...]
"The French hold individual liberty and social equality very dear ... 'liberty, equality, and fraternity' — of course the slogan of their revolution," he says. "And in this country, of course, we have similar ideals: individual liberty, social equality — equal chances for everyone."

But the French have done a better job of protecting those values in health care, Dutton says.

[...]

It's expensive to provide this kind of health care and social support. France's health care system is one of the most expensive in the world.

But it is not as expensive as the U.S. system, which is the world's most costly. The United States spends about twice as much as France on health care. In 2005, U.S. spending came to $6,400 per person. In France, it was $3,300.

Of course, our reliance on two political parties - the Republicans on the one hand and Those that Do As the Republicans Wish While Bitching and Moaning About It on the other - leaves us in the position of choosing between, at most, two health care plans, neither of which is necessarily any good. But compare the French system with its top quality against our bottom of the barrel system, and then tell me that they run at half the price? I want whatever is closer to what they are doing.

Posted by: smijer at August 14, 2008 10:00 PM

Reading through some of the other comments, I might add that I have a nice, 52" plasma TV. I bought it for a small fraction of my healthcare costs. The idea that someone who can afford a plasma TV could just a easily have afforded American healthcare is akin to the notion that the wino who bummed enough for a bottle of Thunderbird could have just as easily used that money to lease a flat on the upper west side.

Posted by: smijer at August 14, 2008 10:04 PM
The French hold individual liberty and social equality very dear

That WAS the place that was on fire & rioting last year, right?

Reading through some of the other comments, I might add that I have a nice, 52" plasma TV.

Well, I don't. Can't afford it. Five figure healthcare costs each year tend to put a damper on such expenditures. I'd like to have one, though. The argument isn't that someone who affords a plasma CAN afford big healthcare bills, it's that the priorities have swung so that people feel they're no longer obligated to pay their debts, instead deciding that some things should be "rights" and let everyone else pay for them.

Posted by: RW at August 14, 2008 11:47 PM

Putting the Rush bashing and anacdotal comments aside; can someone explain to me how having the government take over medical insurance and either making coverage mandatory or optional will reduce the cost of health care? Did someone actually explain this and I missed it?

Posted by: Lee at August 15, 2008 7:42 AM

Hey, get in line! I'm still waiting for all those countries with universal coverage that have higher standards of living than the USA. I'm sure they're lovely places, many of which I'd like to visit, but me knows (David Spade lingo) what the tax rates are in most of those places and the aforementioned France has an unemployment rate of around 20% (IIRC).

Posted by: RW at August 15, 2008 8:38 AM

Lee -

"can someone explain to me how having the government take over medical insurance and either making coverage mandatory or optional will reduce the cost of health care? Did someone actually explain this and I missed it?"

I've alluded to it, but I've never really connected the dots. I don't pretend to be an expert on this issue, so someone can correct me if I've missed something.

The idea is to provide an alternative health care plan that is more affordable than the ones available privately. This is expected to save costs because when people are covered, they will seek treatment earlier for illnesses, etc. instead of waiting until the illness/injury is severe and going to the emergency room for expensive treatments (and also for very routine illnesses). This in turn reduces everyone's costs because everyone else's premiums were absorbing the costs of those expensive treatments.

The government insurance plans, which don't necessary replace private plans, are designed (supposedly) to be more affordable than the private insurance plans, thereby encouraging (optional) or requiring (mandatory) citizens to purchase it (of course, with contributions from employers). This means of, course, that some of the cost of the government plan will be subsidized.

So basically, the savings will come from lower premiums across the board because expensive interventions will be replaced with less costly procedures early in the game.

This is why I look at it as a cost issue and not as a philosophical debate. We are already paying for their health care. The issue, to an extent, is which is more costly: subsidizing their insurance and encouraging them to get earlier treatment or keeping the status quo and paying indirectly for expensive interventions in the emergency room?
For me, a government plan would have to at least break even to be worthwhile.

Posted by: MVH at August 15, 2008 9:46 AM

I should note, though, that there are ancillary benefits, at least in theory, from universal insurance coverage that have nothing to do with cost, e.g., the insurance will be portable, resources for emergency rooms will be used more appropriately and efficiently, people with preexisting conditions will be covered, employers don't have to manage the whole thing, etc. etc.

Posted by: MVH at August 15, 2008 9:53 AM

MVH,

Thanks for the summary. However I am not sure that the idea that cost is what is stopping people from getting earlier treatment. While early diagnosis and treatment are good things, IMHO people don't go to the doctor for a number of reasons not just cost.

I'd like to RELIABLE study data that shows that cost of going to the doctor for early treatment is the MAJOR reason people don't go AND that BECAUSE they don't go the EVENTUAL costs are higher. Notice it is not just proving that early treatment=eventual lower costs BUT also that those people did not go for early treatment because of costs TO THEM.

If I accept the above premise, then why don't existing health care insurers encourage more people to seek eary diagnosis/treatment. Well actually they do. The low co-pays for "wellness visits" do this.

So if the people that buy health insurance are encouraged to get early diagnosis/treatment, then is the reason the INSURED people's costs are high because the costs for NON-insured people drive up the overall costs for all of us? If this is true, I'd like to see real data to support this premise.

So far in the the whole debate (not just on this site), I see a real lack of root cause analysis. We can't plan out an approcah to fix things unless we know exact what the root causes are!

Posted by: Lee at August 15, 2008 11:00 AM

See is you can follow the dots between what macsonix wrote about on August 14th at 8:11 pm and the $400 million Rush is paid to speak about the issues America faces.
My brother is a Conservative and always dismisses any argument that brings up Limbaugh. I remind him Rush is paid big money to keep the rubes confused. His career is like a $400 million game of hide-the-pea.

Posted by: Berto at August 15, 2008 11:07 AM

Well, I don't know about the reliability; we're going to have to take it for granted that Harvard U, a very influential healthcare policy collective, and a group of medical cost experts know more about the subject than any of us, or Mr. Limbaugh, for that matter.

how about this study:
http://www.nchc.org/facts/cost.shtml

or this one:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=402531
another article, same study:
http://www.nytimes.com/2008/07/17/business/17health.html

or this one:
http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.63/DC1

Posted by: macsonix at August 15, 2008 11:17 AM

"I'd like to RELIABLE study data that shows that cost of going to the doctor for early treatment is the MAJOR reason people don't go AND that BECAUSE they don't go the EVENTUAL costs are higher. Notice it is not just proving that early treatment=eventual lower costs BUT also that those people did not go for early treatment because of costs TO THEM."

I don't know what's out there on that. A few things to keep in mind, though. There already is plenty of research to suggest that some people avoid the doctor for reasons other than cost - particularly men. But for the uninsured, the cost is so prohibitive that you've essentially removed the choice altogether. This especially affects young children who can't choose for themselves, and even adults who avoid the doctors themselves would still bring their children). As for the low wellness co-pays, keep in mind that they would have to be able to afford the insurance premiums in the first place in order to obtain the low wellness copays.

Posted by: MVH at August 15, 2008 11:30 AM

"Thanks for the summary. However I am not sure that the idea that cost is what is stopping people from getting earlier treatment."

That's what was perplexing me. Here's the proposed scenario: People don't go to the doctor because they can't afford it, so they wait until they go to the doctor via the emergency room where they don't have to pay for it.

?

"See is you can follow the dots between what macsonix wrote about on August 14th at 8:11 pm and the $400 million Rush is paid to speak about the issues America faces."

Yes, Berto, the actual case is always - each and every time - the one that is most satisfying to your political ends. It cannot be, in the free market, that someone who succeeds is actually the best at what they do, is able to garner the largest demand for their product and thus are able to charge confiscatory rates (voluntarily, mind you) for the continued receipt of the service. No, that can't be. On the surface, yeah, that's what's obvious, but that must be the old 'black and white' thing that the dumbed down public can't understand....instead of the shades of gray that you guys can visualize so well. Nuance, yeah. Can't be someone accomplishing a goal and being number one, no, it's gotta be rubes buying snake oil.

That's always the case, ain't it?

Gee, you'd think that you guys, who can always spot the rubes and the people capitalizing on it, would be able to out maneuver them.

It's not like you've never tried.
Mario Cuomo tried. Failed.
Al Franken tried. Failed.
Janeane Garofolo tried. Failed.
Lowell Weicker tried. Failed.
Jesse Jackson tried. Failed.
Randi Rhodes tried. Failed.
Jane Fonda & co. tried. Failed.
The entire Air America network tried (with free publicity). Failed, miserably.
Mike Malloy tried. Failed. Miserably.

If you know the deal - and you must because you told your brother you did - then maybe you could inform the big-wigs on the left how they can score a Limbaugh-esque deal.

That would help everyone: they'd be rich and no longer need to run to the government for continual handouts and instead donate money to 'the cause' (the DNC, paying the health care of their neighbors....hey, they want to force me, I'm sure they'll volunteer with the largesse), the taxpayers would win because they wouldn't be forced to pay for the gimme programs for those folks, and the public would win because there'd finally be some competition for Rush and a healthy debate is always good.

So.....exactly what is stopping all you guys from ousting Rush & finding success in the open market? Or, is it easier to sit idly by and aim potshots at those who you dislike & expect everyone to accept them as fact?

Posted by: RW at August 15, 2008 11:55 AM

I'm providing a link to this site, which I've chosen because it's advocacy group that is in favor of a single-payer system, but nevertheless states that the ER situation is NOT how I describe it above:

http://www.pnhp.org/blog/2008/07/21/our-ailing-emergency-rooms/

Here is a quote:

"ER delays have become routine in America, even as they prove deadly. We remember Edith Rodriguez, Christopher Jones, Beatrice Vance and recognize that many unknown others have died waiting for emergency care.

Hospital ERs, by law, must welcome all patients who present for treatment. Hence last year’s Presidential quip, “I mean, people have access to health care in America. After all, you just go to an emergency room.” Yet over recent years we have seen our ERs progressively overwhelmed.

The Institute of Medicine reported in 2006 that ER visits climbed more than 25 percent over ten years while the number of hospital emergency departments declined by about 10 percent. No wonder we have overcrowded ERs and longer wait times.

For several years the fact that emergency room delays can mean life or death has made its way into the mainstream discussion.

This year, a benchmark study, by Dr. Andrew Wilper and other Harvard researchers, published in Health Affairs, found that heart attack patients admitted to the ER in 1997 typically waited 8 minutes for treatment, but in 2004 waited 20 minutes, a 150 percent increase.

Because hospitals often lack sufficient inpatient beds, as well as nurses, critically ill or mentally ill ER patients “boarding in the ER,” waiting for intensive care or a psychiatric unit can create a bottleneck, leading to a backup for hours, even days, ultimately causing the diversion of ambulances to another hospital and a greater risk of death for those who are critically ill.

Surprisingly, insured Americans crowd the ERs, not the uninsured. This spring the Annals of Emergency Medicine published a study by Dr. Ellen Weber (and others) that shows the proportion of the uninsured who go to the emergency room declined modestly over a 7 year period, a time when the proportion of uninsured in America rose steadily.

Private health insurance has erected financial disincentives that convince patients to avoid care, for the costs of premiums, co-pays, deductibles and other out-of-pocket expenses have outstripped wages. These days far too many, insured and uninsured, wait to seek medical attention until they are simply too sick to avoid the emergency room. And far too many lack primary and preventive care.

If patients who leave the ER are likely to find themselves bewildered about their treatment, what it means to have insurance “coverage” can be more confusing. A visit to the ER can bring on the up-front co-pay, the daunting deductible (listed on the bill as the “patient responsibility”), as well as other unaffordable out-of-pocket costs, all of which combine to clobber our families financially."

There is a link to the Weber study in the article. They synopsis of that study is as follows:

Study objective: The rise in emergency department (ED) use in the United States is frequently
attributed to increased visits by the uninsured. We determine whether insurance status is associated
with the increase in ED visits.
Methods: Using the national Community Tracking Study Household Surveys from 1996 to 1997,
1998 to 1999, 2000 to 2001, and 2003 to 2004, we determined for each period the proportion of
reported adult ED visits according to insurance status, family income, usual source of care, health
status, and outpatient (non-ED) visits. Trends over time were tested for statistical significance.
Results: The proportion of adult ED visits by persons without insurance was stable across the
decade. Uninsured individuals accounted for 15.5% of ED visits in 1996 to 1997, 16.1% in 1998 to
1999, 15.2% in 2000 to 2001, and 14.5% of visits in 2003 to 2004 (P for trend.43). The
proportion of visits by persons whose family income was greater than 400% of the federal poverty level increased from 21.9% to 29.0% (P.002). The proportion of visits by those whose usual source of care was a physician’s office increased from 52.4% in 1996 to 1997 to 59.0% in 2003 to 2004 (P.002), whereas the proportion of visits by those without a usual source of care was essentially unchanged (9.7% of visits in 1996 to 1997 and 9.6% in 2003 to 2004; P.74).
Conclusion: The rise in ED visits between 1996 and 2003 cannot be primarily attributed to the
uninsured. Major contributors to increasing ED utilization appear to be disproportionate increases in
use by nonpoor persons and by persons whose usual source of care is a physician’s office."

Posted by: MVH at August 15, 2008 12:02 PM

"I suppose if I declined my health insurance and finagled a way to get my family on Mediciad, then I would fit Rush's description of a free rider"

Actually, you'd fit pretty much every description of a free rider.

Posted by: RW at August 15, 2008 12:09 PM

MVH, you brought up an excellent point about the portability issue. HUGE item.

"Major contributors to increasing ED utilization appear to be disproportionate increases in
use by nonpoor persons and by persons whose usual source of care is a physician’s office."

Yeah, as my earlier link noted (purely anecdotal), that was the case from my experience. You have people sitting in emergency rooms because their kid obviously had some sort of sinus/respiratory infection of some sort (and the parents had to leave the ER to go smoke while awaiting a nurse.....yeah, surprise) so that the ER doctor could prescribe amoxil. That is not an uncommon scenario, either. There can be very understandable circumstances, so I'm not slamming the parents, per se, as a risk of pneumonia is nothing to....ahem, sneeze at (had it 4 times, myself). But, common sense does need to enter the discussion. There is a difference between a ruptured appendix and your 2 year old with a sinus infection that you didn't tend to. Like Ron White says, you can't fix stupid. We can sure pay for it, though.

Posted by: RW at August 15, 2008 12:17 PM

MVH,

Thanks for the link, I will spend sometime reading it in detail.

My quick read is that the article (not the Weber study) first only talks about the ER, not costs in general. Secondly, it contains alot of "opinion" not facts.

Its key statement is:

Private health insurance, with its unaffordable costs and its billing games, with its intolerable intrusions into personal and professional decisions, undermines both patients and caregivers. Private health insurance must be replaced by public financing.

Single-payer reform of the American health system offers the minimum incremental change needed to improve the care of patients, lessen inequalities and disparities in care, defend and expand patient choice and autonomy, redistribute resources toward care, toward our emergency rooms, and away from bureaucratic waste, profit-making, personal gain and thus reign in costs.

They don't say how a single payer system will reduce costs, it just dumps on the existing system and how bad the private health insurance companies are. No real plan is provided nor how that plan will address the issue. By the way, what is the issue they are trying to solve? I did not see it in their article.

So given that the ER is filled with INSURED people, not UNINSURED people; please state what is the issue that we are trying to solve?

Posted by: Lee at August 15, 2008 12:34 PM

Lee,

Well, the basic issue is how to make health insurance more affordable because the number of uninsureds who are priced out of the market - and I really do think that many are priced out of the market as opposed to "not choosing" to have health insurance - is staggering and is unlikely to abate. I don't think too many people debate that, including McCain.

I thought that one of the arguments in favor of a gov't plan was the cost savings issue based on the ER - an argument which seems to have lost a lot of its force based on the study I cited.

Both plans by McCain and Obama rely in part on a gov't subsidy to fix the problem. McCain, in the form of a tax credit -$2500 or so a year for health care, and Obama the subsidized Congressional health program.

McCain's is interesting because it does solve the portability issue - if individuals buy their own, they don't have to worry about employment. I don't remember if he had a plan to make up for the shortfall in tax revenue because that's a big hit. This helps the uninsured and avoids the moral hazard because you have to purchase health care to get the credit. On the other hand, it does create a cash-flow problem in the first year because you have to pay for the insurance before you can receive the credit and presumably, they don't have a lot of money in the first place.
One of the other problems is the uninsureds with pre-existing conditions. McCain's plan won't really help them at all.
Businesses would love McCain's this because it takes them out of the loop entirely. But I wonder what insurance companies will do with regard to pooling. Insurers were easily able to pool risk by agreeing to take on all of an employer's employees. How will they do this if everyone is on their own? Will insurance rates go up even more?


Posted by: MVH at August 15, 2008 12:57 PM

MVH,

I would support an employer getting out of the business of joining up with a specific health care provider and instead let me pick my own. If the money they give me to help pay for this is tax free to them and me; that would be essential.

So then it would be a free market system, which might be an improvement. OR it might be a mess. I am not sure.

So basically we are back to the question "How can we lower the cost of health care?" The assumption is if we can do that, then everyone benefits.

Based on that question, what are the leading drivers for the price of health care? Is it the profits of the providers and the insurance companies? Is it the due to demand for services by the insured? Is it government regulation? Is it malpractice insurance due to excessive litigation and judgements by courts? What are the contributors and how can these be attacked?

If we can get down to these issues and away from ideology; we can actually work on the problem instead of spouting politcal propaganda.

I want to compliment you on keeping this dialogue on an intelligent level. Sometime the internet can get kind of wild!

Posted by: Lee at August 15, 2008 2:50 PM

Most of what I know about the insurance industry comes from the fantastic book Against the Gods. My recollection of it is that there are fantastic profits to be made in the business, but like other risk-laden ventures, you've got to know what you're doing.

Most of what I know about the health-care business comes from a friend who is a neurologist and another who is a longtime headhunter for the industry. They both have told me before that it's not the providers who are driving costs in healthcare...it's the insurance companies and their responsibilities to shareholders, overall sustained periods of economic uncertainty which adversely affect insurers, and also the pharma companies and their own efforts to create shareholder value. I would think that the interaction between these entities would create a third pressure on driving costs upward.

Don't know if this helps, but that's what I got. And you're right Lee, it's nice to have an issue-based discussion free from dogmatic grandstanding.

Posted by: macsonix at August 15, 2008 3:42 PM

"Based on that question, what are the leading drivers for the price of health care? Is it the profits of the providers and the insurance companies? Is it the due to demand for services by the insured? Is it government regulation? Is it malpractice insurance due to excessive litigation and judgements by courts? What are the contributors and how can these be attacked?"

Good questions - I'll hunt around for some studies.

One of my biggest fears is that if we move away from employer-based pooling, insurance companies will find a way to price based on someone's individual risk. By this I mean, give someone really good rates and give someone else astronomical rates based on some formula of risk assessment. I'd rather not see health insurance go in that direction.

And thanks for the compliment - you too by the way. I'm on here to learn for the most part, and it's good to have all these people to hash out the issues.

Posted by: MVH at August 15, 2008 4:14 PM

To the person who asked (and the person who answered in part) how an alternative health care system can provide better benefits at lower cost (as do practically every health plan in the industrialized world)...

Well... some other reasons:
1) (Restating what came before) - removing the disincentives for cheaper preventative care (or incentivizing it outright) / reducing need for more expensive critical care
2) Price controls
3) Disincentivizing large advertizing budgets in favor of production and/or
4) Widely distributed standards enables cost-saving computerized record keeping
5) "volume" discounts - it's cheaper per capita to provide for 100 than for 50.

These are just a few things I can think of.

Posted by: smijer at August 15, 2008 5:25 PM

3 was and/or research and development

Posted by: smijer at August 15, 2008 5:29 PM

"I want to compliment you on keeping this dialogue on an intelligent level. "
I second that. I'm used to that with smijer, but it's rare nowadays.

Of course, I'm usually to blame. :)

Posted by: RW at August 15, 2008 7:40 PM

tell me lies, tell me sweet little lies

Posted by: smijer at August 15, 2008 8:54 PM

RW at 11:55,
How can the Left score a deal like that?
EASY, carry the water for those that are in power.
Don't believe me. Tim Russert , the lifelong Democrat (which is supposedly "the Left"), was a multi-millionaire with a home in Nantucket when he died.
He carried the water for those in power.

Posted by: Berto at August 16, 2008 12:51 AM

RW,
Point made. Madonna, Paris Hilton, and Lindsay Lohan? Just the free market putting money in their pockets.
"Hollywood elites"? You mean "free-market capitalists".

Whatever. When you get some consistency, give me a call.

Posted by: Berto at August 16, 2008 1:13 AM

Steve:

I don't care what books have been written critiquing Rush's other arguments. An argument was made here. And you have yet to actually address that particular argument. You've resorted to ad hominem attacks. Who cares who is making the argument. If it makes sense, it makes sense. If it doesn't, explain why.

Posted by: Joel B. at August 16, 2008 3:37 PM

Joel:

Rush's argument was ridiculous because he assumes that people who can afford health insurance would rather spend it on frivolous purchases. Where is the evidence of this? Where is it proven that people intend to have others pay for their health care? It's too expensive; that's why people don't have it. This reminds me of Reagan's B.S. about the welfare queen who drives a Cadillac. When reporters tried to find out more about this woman, Reagan's aides admitted that he made the story up. This is part of the right wing effort to roll back the New Deal. The debate in this comment thread is far more enlightening than anything that I have heard on Rush's show.

And, when the messenger is a schmuck, like Rush is, then by all means attack the messenger. Anyone who listens to Rush for policy discussions is doing themselves a great disservice.

Posted by: Steve at August 16, 2008 4:49 PM
Where is it proven that people intend to have others pay for their health care?
Obviously, the money for single-payer is indeed going to grow on magic beanstalks. Posted by: RW at August 16, 2008 10:52 PM

smijer,

You listed these reasons that government supplied heath insurance will cost less:

1) (Restating what came before) - removing the disincentives for cheaper preventative care (or incentivizing it outright) / reducing need for more expensive critical care
2) Price controls
3) Disincentivizing large advertizing budgets in favor of production and/or
4) Widely distributed standards enables cost-saving computerized record keeping
5) "volume" discounts - it's cheaper per capita to provide for 100 than for 50.

Let me comment one by one:

1) I don't see anyone proving that people are today NOT pursuing preventative care. Where was it shown?

2) Price controls have not shown a means to keep prices lower for REAL. Price controls artificially keep a price for the specific purchaser lower when they buy that item. But usually the costs not passed on to the purchaser are paid by government funding-meaning us.

3) How much does advertizing costs us as a % of what we pay? I doubt if it is >15%.

4)There are already computerized recordkeeping. It is not clear that the lack of this is costing more.

5) Private heath insurance companies are already getting volume discounts on drugs, etc.

In all of the above, what does the government bring to this that makes them better to proivde insurance than private companies? The government has not shown any ability in other progarms (medicare/medicade/social security, etc.) to do a better job than private industry.

I recall studies that show that for every $1 the government funds a program, less than 50 cents actually gets to the people the program was for. The rest gets "wasted" by the governement overhead, etc.

So smijer, what actually data is there as to what makes up the costs for health care so we can pursue specific things to reduce costs?

Posted by: Lee at August 17, 2008 2:03 PM

I've tried to find a relatively unbaised discussion of health care costs, and I've found this from the Congressional Budget Office:

Techonological Change and the Growth of Health Care Spending - January 2008

http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-TechHealth.pdf

Look in particular at figure four on page 6 - Real Spending in Health Care in Selected Categories, 1965-2005.

The CBO's basic conclusion:

"From 1965 to 2005, real health care expenditures per capita increased nearly sixfold in the United States. That large increase was the combined result of many factors, and accounting precisely for all of them is difficult. Nonetheless, the general consensus among health economists is that growth in real health care spending was principally the result of the emergence of new medical technologies and services and their adoption and widespread diffusion by the U.S. health care system."

Posted by: MVH at August 18, 2008 12:20 PM

Another superb find by MVH!

This table is critical:

Estimated Contributions of Selected Factors to Growth in Real Health Care Spending Per Capita, 1940 to 1990

Aging of Population: 2%
Changes in 3rd Party Payment: 10%
Personal Income Growth: 11-18%
Prices in the Health Care Sector: 11-22%
Administrative Costs: 3-10%
Defensive Medicine and Supplier-Induced Demand: 0%
Technology Related Changes: 36-62%

The one caveat is that the % for technology was estimated by adding the non-technology numbers and subtracting those from the overall increase. The assumption being that since it was none of the others; it must be technology. A debatable assumption but at least it has some basis.

This statement in the report is direct:

"Since technological change is the biggest contributor, an effective long-term strategy for controlling health care spending will probably have to address the health care system’s way of incorporating new technologies into practice.
Future increases in spending could be moderated if costly new medical services were adopted more selectively in the future than they have been in the past and if diffusion of existing costly services was slowed."

So this report does not blame insurance providers, doctors, drug companies, or any political sector. Rather it makes a specific recommendation as to how to slow costs in the future.

So I would observe that the above being true, the government offering health insurance does not seem to be effective approach to reducing costs. Correct? QED

Posted by: lee at August 18, 2008 1:12 PM

Lee,

Don't give me too much credit; google did most of the work!

"So I would observe that the above being true, the government offering health insurance does not seem to be effective approach to reducing costs. Correct? QED"

Correct - it will not reduce costs for everyone in the way that I earlier thought. The study doesn't demolish the case for the government health insurance program, though. One could argue that a subsidized plan is necessary so that the rising costs of these new technologies don't price the underinsureds out of the market.

I don't what to make of the CBO recommendation to be honest. It sounds a little silly. How would we go about making sure that "costly new medical services were adopted more selectively", and who make that decision? Limit services that doctors provide to patients? Tell insurance companies what new technologies to cover? Those are exactly the kinds of decisions that I -would not- want the government to make.

Posted by: MVH at August 18, 2008 1:51 PM

I also am perplexed how the CBO would implement their recommendation. Make the patient pay for these? Offer programs where the patient could cover these or not? I agree, these are not the type we want governments to make; rather I would like to be able to make these for myself.

One thing on subsitizing; the money has to come from someone. This is a zero sum game. It all comes back to the basic issue of how much should those who earn the $ have to pay to cover those who can't afford it?

If you keep raising taxes on those who make money, then they become the very people you need to give money to! Working hard and making money to provide a better life for your family should not be punished with higher taxes to pay for those who won't (don't confuse this with people who can't) work harder.

Posted by: Lee at August 18, 2008 2:54 PM

One more observation for all of us.

Notice how once you start collects facts and looking for root causes, the discussion becomes clearer? People even find common ground and find they agree more than they thought?

What started out as a sniping about politcal issues and slamming people was turned into a search for facts followed by some rational discourse.

Note to self:
Less sniping and more factual based discussions=better results.

Posted by: Lee at August 18, 2008 2:59 PM

"One thing on subsitizing; the money has to come from someone. This is a zero sum game. It all comes back to the basic issue of how much should those who earn the $ have to pay to cover those who can't afford it?"

Yup. But there are some complicating factors here. One is that not all employers offer health care benefits and many are cutting back, which means you can be working hard and still not be able to afford insurance. Also, real wage earnings definitely have not kept pace with the rising health care costs.

Still, I'm not willing to move to a Canada/UK health care system. I'm willing to consider some of those plans out there, whether McCain's or Obama's or someone else's, but how much will it cost, where is the money coming from, and can we afford it anyway given our national debt/deficit?

Posted by: MVH at August 18, 2008 3:45 PM

"Less sniping and more factual based discussions=better results."

You asked good questions too. And it always helps to have relatively unbiased studies from the CBO, and from this year no less. Who would have thought? Usually, out of necessity, we have to deal wth references to politically-affiliated "policy" organizations, which some tend to reject out-of-hand.

I doubt we've had the last word. Crank hasn't even weighed in yet, and how could he resist?

Posted by: MVH at August 18, 2008 4:54 PM

I agree! Crank 'er up Crank!

Posted by: Lee at August 18, 2008 6:27 PM

I stand corrected - maybe we did have the last word! I thought we'd at least see a few conflicting studies get posted.

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