That’s what I asked him in a recent Intelligence Squared debate on universal coverage, which can now be viewed in about 12 bite-sized pieces on YouTube. 

The full transcript is available here.

As a political expedient designed to give George W. Bush a second term in the White House, Karl Rove convinced, cajoled, and browbeat congressional Republicans into creating Medicare Part D, the program’s new prescription drug benefit and the largest expansion of the entitlement state since the creation of Medicare itself. One of the Bush administration’s selling points was that creating a prescription drug benefit in Medicare would allow the GOP to steal the health-care issue from Democrats. Instead, Republicans may have done little more than slit their own throats.

An article in Politi​co​.com (“Big pharma veers to the left”) discusses how Part D has delivered the pharmaceutical industry — long a supporter of Republican congressional candidates — into the hands of Democrats:

The growth of state and federal health care programs — including President Bush’s prescription drug plan for seniors — means that today about half of the pharmaceutical market is controlled by government.

That got the industry rethinking about how to position itself politically. And the future seems to be in ensuring that the government programs remain robust and generous.

Whereas big-pharma political giving used to run 3–1 in favor of Republicans, it is now running even between the two political parties.

Isn’t the whole point of selling out your principles that you’re supposed to get something in return?

In a previous post, I wrote the following about friend and debate partner Sally Pipes:

And I’m now prepared to induct John Stossel into the Anti-Universal Coverage Club. Sally Pipes I’m still not sure about; you can judge for yourself when the IQ2 folks post the transcript of the debate here.

My intention was not to disparage Pipes. The Anti-Universal Coverage Club exists to challenge the idea that government should pursue a policy of universal health insurance coverage. Some free-marketers believe that’s a fine goal, so long as government goes about it using market mechanisms. At our recent Intelligence Squared debate, Pipes remarked:

By supporting universal choice in health care, and empowering consumers, we will achieve universal coverage.

Pipes is one of the leading opponents of government-run health care. When I heard that remark, though, I thought perhaps Pipes might fall into that aforementioned group of free-marketers. So I didn’t want to induct her into the Anti-Universal Coverage Club if that’s not her thing.

Colleagues of Pipes objected to my blog post. In an email to me, Pipes writes:

I support allowing the market to work resulting in more choice for consumers. The government should not be involved.

I did not mean to suggest anything to the contrary, but I can see why they would think I had. I apologize to Pipes and her colleagues.

In a study released today by the Cato Institute, economist and Cato adjunct scholar Shirley Svorny says no:

In the United States, the authority to regulate medical professionals lies with the states. To practice within a state, clinicians must obtain a license from that state’s government. State statutes dictate standards for licensing and disciplining medical professionals. They also list tasks clinicians are allowed to perform. One view is that state licensing of medical professionals assures quality.

In contrast, I argue here that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible. Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.

Consumers would benefit were states to eliminate professional licensing in medicine and leave education, credentialing, and scope-of-practice decisions entirely to the private sector and the courts.

If eliminating licensing is politically infeasible, some preliminary steps might be generally acceptable. States could increase workforce mobility by recognizing licenses issued by other states. For mid-level clinicians, eliminating education requirements beyond an initial degree would allow employers and consumers to select the appropriate level of expertise. At the very least, state legislators should be alert to the self-interest of medical professional organizations that may lie behind the licensing proposals brought to the legislature for approval.

Svorny’s study is titled, “Medical Licensing: An Obstacle to Affordable, Quality Care.”

The results are in from last night’s Intelligence Squared debate on universal health coverage:

• Before the debate, 49 percent of the audience was pro-universal coverage, 24 percent anti‑, and 27 percent undecided.
• After the debate, 58 percent of the audience was pro‑, 34 percent anti‑, and 8 percent undecided.

As many have noted, the anti- side won over more of the undecideds (10 percentage points) than did the pro- side (9 percentage points). Considering this was a crowd of mostly Manhattan denizens, I’m pleasantly surprised by the outcome.

And I’m now prepared to induct John Stossel into the Anti-Universal Coverage Club. Sally Pipes I’m still not sure about; you can judge for yourself when the IQ2 folks post the transcript of the debate here.

EDITOR’S NOTE: See clarification concerning Pipes here.

In this morning’s Washington Post, columnist Bob Samuelson earns himself a membership in the Anti-Universal Coverage Club:

At the Democratic National Convention, Sen. Ted Kennedy echoed the view of many that health care is a “right” that demands universal insurance. This completely understandable view is, I think, utterly wrong. Take note, Barack Obama and John McCain.

The central health-care problem is not improving coverage. It’s controlling costs.

Welcome, Bob. Here’s your fez.

You can keep current on the Anti-Universal Coverage Club by clicking here.

Health economist Dana Goldman, according to his bio, “holds the RAND Chair in Health Economics and is the Founding Director of the Bing Center for Health Economics at RAND. He is also an Adjunct Professor of Health Services and Radiology at UCLA.” He also started a peer-reviewed journal or something. So, not exactly a slouch in the health policy/​economics realm.

In a contribution to Cato Unbound a little while back, Goldman wrote the following, which qualifies him for membership in the Anti-Universal Coverage Club:

the health policy debate is preoccupied with the wrong issues — for example, covering the uninsured. The real challenge for society is deciding how we can best buy better health, not just health care. In fact, I suspect that early child development, education, clean air, and medical research may offer better returns than health insurance and more medical services. But it may also turn out society should be spending more, not less, on medical care — just doing so in a more prudent manner.

Emphasis added.

Keep up-to-date on the Anti-Universal Coverage Club here.