Tag: Health

There Ain’t No Such Thing as Market-Based Universal Coverage

Over at The Corner, Harvard Business School professor and Manhattan Institute scholar Regina Herzlinger urges conservatives to support universal coverage – but in a market-oriented way. That is an absurdity. Once the government adopts a policy of universal health insurance coverage, a free market is impossible and the casualties begin to mount.

As a model, Herzlinger points to Switzerland, “which enables universal coverage without any governmental insurance through this system.” Switzerland requires all residents to purchase “private” health insurance; dictates the content of that insurance; and dictates the price. As I explain in a recent Cato paper, once the government controls those decisions, you’ve got socialized medicine.

My colleague Mike Tanner observes that the Swiss government’s power to control the content of “private” health insurance allows special interests to lard up people’s health insurance with their services – whether Swiss consumers want them or not:

The expansion of benefits has driven up the cost of insurance…As Uwe Reinhardt has noted, “Over time, the growth in compulsory benefits has absorbed an increasing fraction of the consumers’ payment, thus compromising the consumer-driven aspects of the Swiss system.”

Tanner also reports that the government’s power to dictate health insurance premiums is harming the sickest Swiss:

Evidence shows that the community rating requirements are…leading to the over-provision of care to the healthy and the under-provision of care to the sick. In addition, the prohibition on risk management discourages the development of new and innovative products.

In this Cato paper, University of Chicago business school professor John Cochrane explains how such price controls harm sick patients and suppress innovative new products.

Herzlinger is an extremely passionate and knowledgeable advocate of market-based health care. But when it comes to universal coverage, readers of National Review are better counseled by the magazine’s editors, who write:

to achieve universal coverage would require either having the government provide it to everyone or forcing everyone to buy it. The first option, national health insurance in some form or other, would either bust the budget or cripple medical innovation, and possibly have both effects. Mandatory health insurance, meanwhile, would entail a governmental definition of a minimum package of benefits that insurance has to cover…

Republicans should go in a different direction, proposing market reforms that make insurance more affordable and portable. If such reforms are implemented, more people will have insurance.

Some people, especially young and healthy people, may choose not to buy health insurance even when it is cheaper. Contrary to popular belief, such people do not cause everyone else to pay much higher premiums. Forcing them to get insurance would, on the other hand, lead to a worse health-care system for everyone because it would necessitate so much more government intervention. So what should the government do about the holdouts? Leave them alone. It’s a free country.

Herzlinger is correct that “it is 2009, not 1992.” If we want America to remain a free country in 2009 and beyond, we must reject universal coverage.

This Is Why Universal Coverage Is a Religion — and Not about Compassion or Saving Lives

I was invited to participate in an email/online/sorta exchange for the Washington Post yesterday.  Unfortunately, the effort was spiked after just a few rounds of emails.  But rather than let my participation go to waste, I thought I’d post one exchange that I think highlights why I’m not just being colorful when I describe supporters of universal health insurance coverage as the Church of Universal Coverage.  I could summarize the exchange, but I’m lazy.  So I’ll just copy and paste.

I wrote:

All the interest groups are meeting with all the right politicians and making all the right noises, thus the Church of Universal Coverage says the stars have aligned for fundamental reform… Everyone is at the table right now because no one wants to be on the menu.  But when the Democratic leadership makes its intentions clear, today’s love-fest will turn into a bloodbath.

Andres Martinez of the New America Foundation (who owes me a taco al pastor) responded:

I am a proud member of the church, Michael.  As New America’s own recent study on the urgency of reform – which reads like a strong courtroom closing argument – noted, how can the world’s most prosperous nation afford to have tens of thousands of its citizens die each year because they lacked access to health care?  Health care reform is a moral imperative, so your reference to a church (um, even if sarcastic) is appropriate…

I replied:

The Institute of Medicine estimates that every year, about 20,000 Americans die because they lacked health insurance, but as many as 100,000 die from preventable medical errors.  What moral code compels the Church of Universal Coverage to solve the first problem before addressing the second?

Elise Gould of the Economic Policy Institute (whose working paper, “Who is Adversely Affected by Limiting the Tax Exclusion of Employment-Based Premiums?”, I am keen to read) chimed in:

In an answer to Michael’s post about the deaths caused by lacking health insurance as compared to those from preventable medical errors, I’d argue that it’s much easier to solve the second when you have people in a common system (i.e., solving the first).

Me again:

To say that universal coverage will make it easier to reduce medical errors is pure fantasy.

The principal reason we have too many medical errors is that fee-for-service payment dominates America’s health care sector, and fee-for-service rewards medical errors and punishes efforts at error reduction.  The reason fee-for-service dominates is government.  Medicare – the single-largest purchaser in the world – pays largely on that basis.  Ditto Medicaid.  And the federal tax code encourages fee-for-service by insulating consumers from the cost of their health coverage.  If you think it’s hard for government to change payment systems now, just wait until universal coverage gives government even more control over payment systems and makes even more providers dependent on those decisions for even more of their income.  (As an aside, when consumers control their health care dollars and choose their health plans, they can change payment systems in a heartbeat.)

This is why universal coverage is a religion: supporters believe that universal coverage has magical, supernatural powers to suspend political reality and the laws of economics.  I do not exaggerate.  See here and here.

Health care reform is a moral imperative.  But universal coverage is not a moral imperative, nor is it about compassion or saving lives.

For those who are interested, the Anti-Universal Coverage Club is still accepting new members.

Len Nichols Is Wrong: This Debate Is about Socialized Medicine

Over at “The New Health Dialogue Blog,” my friend Len Nichols writes:

I am disappointed to hear the health reform conversation devolve once again into a contrived debate about a single payer, government-run health system. This is an old dispute about “socialized medicine” and one that has already been settled in the minds of a critical mass of policymakers.

A couple of things strike me about his post.

First, this debate is obviously about socialized medicine, and to argue anything else is absurd. We have a president who advocates single-payer. That president just held a health care summit to which he invited other single-payer advocates, but not a single free-market advocate. As I explain in this paper, all the bluster about “public-private partnerships” is an intellectually dishonest smokescreen. Nichols and other members of the Church of Universal Coverage hate the term “socialized medicine” not because it inaccurately describes their policies, but because it accurately describes their policies and rankles a large segment of the American public. Rather than adjust their policies, they are trying to convince the public that policies generally considered socialist really aren’t.

Second, this “old dispute” obviously has not been “settled in the minds of a critical mass of policymakers.” If that mass of opinion were truly critical, then (by definition) the fact that some are crying “socialized medicine” wouldn’t bother Nichols at all.

I think I’ll shoot my friend an email and invite him to speak at a Cato Institute policy forum where we can discuss whether President Obama is trying to move us closer to socialized medicine.

FutureGen: Economic and Political Decisions

People who support expanded federal intervention into areas such as energy and health care naively assume that policymakers can make economically rational and efficient decisions to allocate resources. They cannot, as a Washington Post story today on FutureGen illustrates.

The story describes the political battle over the location of a $1.8 billion ”clean coal” plant. I don’t know where the most efficient place to site such a plant is, or  if such a plant makes any sense in the first place. But the story illustrates that as soon as such decisions are moved from the private sector to the political arena, millions of dollars are spent to lobby the decisionmakers, and members of Congress are hopelessly biased in favor of home-state spending regardless of what might be best for the national economy as a whole.

President Obama has promised to ramp up spending on such green projects. So get ready for some huge political fights over the big-dollar spoils, and get ready for some monsterous energy boondoggles.

Has He Read the Book?

At yesterday’s White House Summit on Health Care Reform, President Obama had this to say:

If there is a way of getting this done, where we’re driving down costs and people are getting health insurance at an affordable rate and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I’d be happy to do it that way.

Well, Mr. President, may I recommend Healthy Competition: What’s Holding Back Health Care and How to Free It for a detailed proposal for how to accomplish this without turning one-seventh of our economy and some of our most important, personal, and private decisions over to the tender mercies of the federal government.

Of course, as my colleague Michael Cannon points out, no one who supports free market proposals to drive down costs and give consumers greater choice of providers and insurers was actually invited to the summit.

The ball is back in your court, Mr. President.

Week in Review: A Health Care Summit, School Choice and Ayn Rand

Obama Holds White House Health Care Summit

President Obama hosted almost 150 elected officials, doctors, patients, business owners, and insurers on Thursday for a White House forum on health care reform. The Washington Post reports Obama “reiterated his intention to press for legislation this year that dramatically expands insurance coverage, improves health care quality and reins in skyrocketing medical costs.”

Cato senior fellow Michael D. Tanner responds:

The Obama administration and its allies mainly seek greater government control over one-seventh of the U.S. economy and some of our most important, personal, and private decisions. They favor individual and employer mandates, increased insurance regulation, middle-class subsidies, and a government-run system in competition with private insurance. On the other side are those who seek free market reforms and more consumer-centered health care.

These differences are profound and important. They cannot and should not be papered over by easy talk of bipartisanship.

In a new article, Tanner explains why universal health care is not the best option for Americans seeking a better system:

If there is a lesson which U.S. policymakers can take from national health care systems around the world, it is not to follow the road to government-run national health care, but to increase consumer incentives and control.

To find out how the free market system can increase health care security, read University of Chicago professor John H. Cochrane’s new policy analysis, which explains how markets can “provide life-long, portable health security, while enhancing consumer choice and competition.”

Battle Over Washington DC School Choice Program Continues

Congressional Democrats are considering cutting the funding for a pilot education program that sends low-income children in Washington, D.C., to private schools through vouchers. The program serves as an example of how helpful school choice programs can be to children who are born into families that cannot afford to send them to good schools.

Adam Schaeffer, policy analyst at Cato’s Center for Educational Freedom, says even the mainstream media is on the side of school choice this time.

In a recent study, Andrew J. Coulson, director of Cato’s Center for Educational Freedom, demonstrates the superiority of market-based education over monopolies.

For comprehensive research on the effectiveness of charter schools, private schools, and voucher programs, read Herbert J. Walberg’s book, School Choice: The Findings.

Cato Celebrates Women’s History Month

The Cato Institute pays homage to three women during Women’s History Month who unabashedly defended individualism and free-market capitalism early in the 1940s — an age that widely considered American capitalism dead and socialism the future.

In 1943, Isabel Paterson, Rose Wilder Lane and Ayn Rand published three groundbreaking books, The God of the Machine, The Discovery of Freedom and The Fountainhead, that laid the foundations of the modern libertarian movement.

On Rand’s centennial, Cato executive vice president David Boaz highlighted the many contributions she made to liberty:

Although she did not like to acknowledge debts to other thinkers, Rand’s work rests squarely within the libertarian tradition, with roots going back to Aristotle, Aquinas, Locke, Jefferson, Paine, Bastiat, Spencer, Mill, and Mises. She infused her novels with the ideas of individualism, liberty, and limited government in ways that often changed the lives of her readers. The cultural values she championed — reason, science, individualism, achievement, and happiness — are spreading across the world.

A Ditch, Not a Summit

When President Obama opened today’s summit on health care  reform at the White House, he said:

In this effort, every voice has to be heard. Every idea must be considered.

Of course, he spoke those words to a room that contained not a single advocate of free-market health care reform.

  • No one from the American Enterprise Institute (ranked the #5 think tank in the world for health policy)
  • No one from the Cato Institute (ranked #7)
  • No one from the National Center for Policy Analysis (ranked #10)
  • No one from the Manhattan Institute
  • No one from the Pacific Research Institute
  • No one from the Galen Institute
  • No one from the Heritage Foundation
  • The list goes on…

Obama did, however, invite people from left-wing think tanks, including avowed advocates of socialized medicine.  That makes Obama’s pledge of openness a farce, and today’s event a charade.

Or as my colleague Wayne Crews puts it: it’s a ditch, not a summit.