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|September 3 - 9, 2009
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The wrong argument
The Dems’ approach doesn’t explain why the market can’t fix health care
by Chris Gay
If mandated universal health care fails this time around, it will be — as always — partly because right-wing scare tactics and misinformation have prevailed once again. But it will also be because proponents of universal care are once again demonstrating an inclination that late Israeli statesman Abba Eban once famously noted of Arab politicians: When it comes to peace efforts, they “never miss an opportunity to miss an opportunity.”
It’s clear from the deluge of citizen commentary coming out of this month’s town hall meetings that a lot of people don’t have the slightest idea what health care reform is all about. A sterling example is the delirious-looking woman who last week urged Rep. Barney Frank, D-Mass., to “let the private sector do this. This is not a federal government issue; this is a people issue.”
This statement is so rife with confusion it’s hard to know where to begin disentangling it, so let’s stick to the most relevant clause, the first. Anyone who thinks the private sector is the key to a health care solution by definition doesn’t understand the problem — if you identify the problem as the failure of private, for-profit insurers to cover everyone. (If you don’t think that’s a problem, fine, but try getting opponents of reform to say so.)
Expecting for-profit insurers to cover the people who most need care is like expecting to get pinot grigio from a turnip. It won’t happen because it’s not supposed to happen. Private insurers are in business to make profits, as they have every right to be. But insurers don’t maximize profits by insuring the people most likely to need coverage. Therefore — common sense tells us, even if experience did not — to the extent that health care insurance is in private, for-profit hands, there will always be some irreducible number of uninsured people.
The problem in a nutshell: There is a profound conflict between market goals and public-health goals. The private market is constantly working to shrink the risk pool, while the interests of public health demand its expansion. Only extra-market mechanisms can reconcile these conflicting forces. The rest of the industrialized world realized this long ago, which is why the dispensation of health care in Britain, Canada, Japan, or any other society most of us would care to live in is not left entirely to private purchasing power. The U.S. half-realizes this, which is why Medicare and other public interventions account for 46 percent of health care spending in this country.
When President Obama says the health care market “has not worked properly,” he only confuses matters. What does he mean by “worked”? Does he even know? “Worked” for whom? What “works” for a private insurer does not work for the interests of public health. That, indeed, is the heart of the whole issue, the reason we’re having this debate.
Once you understand the problem in those terms — universal coverage as a logical impossibility in a for-profit system — the case for intervention becomes much more compelling, and one becomes far less susceptible to the misdirection and bogus alarums of the right.
But that’s not the argument we’re hearing from reform’s proponents, at least in a venue where most people will hear it. Take President Obama’s Aug. 16 New York Times op-ed, “Why We Need Health Care Reform.” Like every other feature story or stump speech about health care reform, it starts with an anecdote about some poor soul who has lost his job, and therefore his health care, and because of some illness faces the prospect of financial ruin — or death. This is the same hard-luck narrative reform proponents have been selling for 60 years. On YouTube, you can find a video of President Kennedy addressing an overflow crowd in Madison Square Garden in 1962 in support of what in effect became Medicare. Kennedy, too, spun out a version of the hard-luck narrative, punctuated by his dry sense of humor but otherwise the same story.
The hard-luck narrative is moving, but it is not explanatory. It doesn’t explain why the market can’t fix what ails these victims, allowing conservatives to bamboozle folks with the fallacy that the market is somehow the solution. George F. Will, on ABC’s This Week June 21, explained that there’s no need for a so-called public option because there are 1,300 health plan providers in this country. “We have a competitive market in computers without a government computer program,” he said. “A competitive market in car insurance.
Why we need [a public-option health plan] I do not know.”
Whatever you think of the public option, note how that statement gets the logic of health insurance exactly backward. Dell has no incentive to withhold PCs from anyone who wants to buy one. But Aetna has lots of incentive to withhold coverage from people who want it. Indeed, the Law of Inverse Coverage says that the more you want health coverage (i.e., the sicker you are), the less likely you are to get it, thanks to the perverse incentives that govern the health insurance market. As a rule, when people describe the health care market as if it’s just another market, it’s a good clue that either they don’t know what they’re talking about or they’re being disingenuous.
It’s one thing if health reform goes down in flames because people have legitimate, informed concerns about intervention. It’ll be shameful, though not surprising, if it fails because of misinformation. But it’ll be downright tragic if it fails because smart, articulate people failed to make the case they should have.
— Fredericksburg (Va.) Free Lance-Star / MCT
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