Peter Singer has popped up again and he engages in telling us a simple truth about health care – no matter what system you have, health care will be rationed. Well, for those of us who understand supply and demand we’ve always known health care would be rationed. When you have 800,000 doctors in a country of 300 million, it isn’t really that difficult to figure out.
However, that’s really not Singer’s point. If you read through his multiple page piece, you’ll find that he is of the opinion that government bureaucrats would be much better at rationing than would private bureaucrats. And he attempts to make his point by selectively offering facts that will back his position.
But this amazing paragraph pretty much represents where he believes we must go with our health care reform (and indications are our politicians implicitly agree given the goals they’ve set for “reform”):
Of course, it’s one thing to accept that there’s a limit to how much we should spend to save a human life, and another to set that limit. The dollar value that bureaucrats place on a generic human life is intended to reflect social values, as revealed in our behavior. It is the answer to the question “How much are you willing to pay to save your life?” — except that, of course, if you asked that question of people who were facing death, they would be prepared to pay almost anything to save their lives. So instead, economists note how much people are prepared to pay to reduce the risk that they will die. How much will people pay for air bags in a car, for instance? Once you know how much they will pay for a specified reduction in risk, you multiply the amount that people are willing to pay by how much the risk has been reduced, and then you know, or so the theory goes, what value people place on their lives. Suppose that there is a 1 in 100,000 chance that an air bag in my car will save my life, and that I would pay $50 — but no more than that — for an air bag. Then it looks as if I value my life at $50 x 100,000, or $5 million.
Frankly, this paragraph should make your skin crawl. Because what Singer is doing here is presuming we all accept that others, those nameless bureaucrats he’s so fond of if they happen to be from the government, now have the job (and duty) to decide what your life is worth. Not you. Not your family.
No, what Singer proposes is reducing your life to an arbitrary worth beyond which “they” are not willing to pay to save it. Whether you are or not is apparently not a factor in such calculations.
Singer goes on:
Nevertheless this approach to setting a value on a human life is at least closer to what we really believe — and to what we should believe — than dramatic pronouncements about the infinite value of every human life, or the suggestion that we cannot distinguish between the value of a single human life and the value of a million human lives, or even of the rest of the world. Though such feel-good claims may have some symbolic value in particular circumstances, to take them seriously and apply them — for instance, by leaving it to chance whether we save one life or a billion — would be deeply unethical.
“Deeply unethical” for whom? Certainly not the person with the desire and means to do what they feel is necessary to extend their life or the life of a loved one. They, of course, would value human life above the arbitrary level which Singer and “economists” calculate.
But Singer’s premise here is they shouldn’t have that right. Because other’s don’t have the same opportunity. It would be “deeply unethical” for some to be able to “buy” what others can’t afford. So instead, the ethical thing to do is have everyone held to the economically calculated standard, whether they have the means and desire to do otherwise or not.
Of course we can argue this philosophically for decades, but the point remains that rationing is a feature of any health care system. What isn’t a feature of every health care system is choice. What Singer is actually proposing is taking the choice that now exists in our health care system away and putting everyone under the arbitrary rationing guidelines calculated by government.
He says as much in his next paragraph:
Governments implicitly place a dollar value on a human life when they decide how much is to be spent on health care programs and how much on other public goods that are not directed toward saving lives. The task of health care bureaucrats is then to get the best value for the resources they have been allocated. It is the familiar comparative exercise of getting the most bang for your buck.
The best bang for “your” buck? It’s no longer “your” buck at that point. It is the government’s buck and you have no choice in how it will be spent or “saved”. You will, however, be on the receiving end of any decision.
And where that leads (and where Singer was going with all of this to begin with) is found here:
As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds.
Pretty darn predictable, no? This is the logical end of Singer’s rationing policy. Utilitarian calculation based on arbitrary worth. And the inevitable decision to ration in such a way as to deny the elderly because they just aren’t “worth” it anymore.
And that, per Singer, would be very ethical.
Trust me, those collectivist premises are what will drive government run health care’s rationing. Given the goals (more coverage, less cost) they must. Choice will eventually be driven out of the system and, as they must, bureaucrats will decide how long you will be allowed to live.
Count on it.
Just a few of the gems beginning to come out of the Democratic health care reform proposals.
Keith Hennessey wonders if the Democrats really want to tax the uninsured because as the bill is structured a) not everyone will have insurance and b) not everyone will be able to afford it meaning c) they pay a tax. He gives 2 examples:
* Bob is a single 50-year old non-smoking small business employee who makes $50K per year before taxes and does not have health insurance.
* Bob cannot afford a $1,600 bare bones health insurance policy, much less a $3K — $5K policy.
* Bob would get no subsidies under this bill, and his employer would face no penalty for not providing him with health insurance.
* Bob would end up without health insurance and would have to pay $1,150 more in taxes.
Now, what you can expect is not that Democrats would stick with the provisions of the bill, but instead they’d find some way to fold Bob into the program further raising the cost.
Same with Freddy and Kelsey:
* Freddy and Kelsey are a 40-year old couple with two kids. They own and run a small tourist shop in Orlando, Florida.
* They are the only employees, and earn a combined $90K per year.
* They cannot afford even an inexpensive health insurance plan, and so the House bill would make them pay $2,050 in higher taxes.
So given those figures (and be sure to read the whole post by Hennessey) and the estimate of 8 million falling into this category, obviously the bill will cost more than projected.
When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.
It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:
“Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law.
So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
While assuring everyone that the same choices we now have would still in the system, this was discovered a mere 16 pages into the 1,000 page monstrosity. I’m sure there are other gems to be had in there as well. But the obvious point here is this puts people who make the choice, for instance, to go into business for themselves, in a situation where they are unable to buy health insurance from a private carrier, whether they want too or not. Of course, that will go a long way toward killing any private market in that niche of the insurance industry. And where will these people eventually end up? On a subsidized public plan, of course.
If that’s not bad enough, there’s the planned expansion of Medicaid. What the federal government plans to do is expand insurance coverage under Medicaid by 11 to 20 million people depending on which percentage above the poverty rate the final bill has. But states pay a large portion of Medicaid expenses. The House version calls on the fed to pick up all the expenses while promising to enact big savings in the program. The Senate version has the fed paying the full freight for 5 years. The latter is more likely to be the version that would pass simply because they can hold the “cost” numbers down a bit by doing so.
But not so in the states where the mandated expansion of Medicaid will end up having to be funded by each state’s taxpayers.
Keep these in mind as you hear cost figures bandied about by the blowhards on the Hill. They give used car salesmen a bad name.
And yes, that’s right, just because Democrats put “affordable” in the title doesn’t mean it is anything close to being affordable (unless another trillion in spending is something you find affordable). In fact, you can almost count on the opposite being true.
Another vitally important point to keep in mind is that trillion we’re batting around like we’re talking about spending ten bucks, is a government estimate. Anyone remember the government estimate about the cost of Medicare and how that turned out?
The Democrats are claiming the CBO “scored” this bill and it came up under the “affordable” column. But the RNC says the CBO didn’t actually score the language in the bill:
In the second paragraph of CBO’s letter, it says, “”It is important to note, however, that those estimates are based on specifications provided by the tri-committee group rather than an analysis of the language released today.” So they scored what Democrats asked them to score. Not the actual bill.
Yes, in this infernal rush to get a bill out, we obviously couldn’t be patient enough to have the CBO score what the bill actually said vs. what the committees declared the bill would say. And we all know how honest our Congress is about such things, don’t we? Last but not least, the politics of the thing. Here’s a graph to show you how the planned appropriation of your money will take place:
Note carefully when the costs will actually begin to kick in. Yes, when Obama is safely in his second term and hopefully, at least as the Democrats reason, still with a Democrat majority Congress (since both the 2010 and 2012 Congressional elections shouldn’t be effected). Note the slope of the curve after that. Philip Klein, who put the chart together, explains:
It’s important to keep in mind that the most costly aspects of the legislation involve providing subsidies to individuals to purchase health care ($773 billion) and to expand Medicaid ($438 billion), but it takes several years for those provisions to kick in. As you can see from the chart below, that means that the costs start out relatively modest but ramp up over time. In the first three years of the plan the cost of the subsidies and Medicaid expansion is just $8 billion; in the first five years, it’s $202 billion; but in the last five years, it’s $979 billion. Put another way, 17 percent of the spending comes in the first five years, while 83 percent comes in the second five years. What this means is that the American people see $1 trillion over 10 years and they think that means the bill would cost about $100 billion a year — but the reality is more than double that. In the final year of the CBO estimates, 2019, the spending hits $230 billion.
Another important note – at the end of 10 years, that line on the graph isn’t going to drop to zero. It’s going to continue to climb. That’s “affordable?” If so, Democrats have given new meaning to the word. And all of it to be paid for by taxing the rich.
Yes, in the midst of an economic crisis, the con artists in Washington are at it again. They’ve co-opted “affordable” to sell their snake oil, ignored the impact of such a bill in a weak economy but carefully weighed the politics of it, and have decided that funding it on the back of “the rich” won’t have any adverse consequences when it comes to the economy and its health.
You can see this train wreck coming from miles and miles away, can’t you?
I‘m so glad that the Democrats have settled on how to pay for their latest government boondoggle even if it is the same old formula:
House Democrats will ask the wealthiest Americans to help pay for overhauling the health care system with a $550 billion income tax increase, the chairman of the tax-writing Ways and Means Committee said Friday.
The proposal calls for a surtax on individuals earning at least $280,000 in adjusted gross income and couples earning more than $350,000, said the chairman, Representative Charles B. Rangel of New York.
It would generate about $550 billion over 10 years to pay about half the cost of the legislation, Mr. Rangel said. As the proposal envisions it, the rest of the cost would be covered by lower spending on Medicare, the government health plan for the elderly, and other health care savings.
Tax the rich and squeeze the health care industry with lower Medicare payments. Sounds like a very “healthy” and stable way of paying for “health care reform” doesn’t it? A perfectly sure way to accomplish the stated Obama priorities of “expanding health insurance coverage to virtually all Americans and curtailing the steep rise in the cost of medical care while improving patient outcomes.”
Expand coverage, cut payments and improve outcomes.
Yup – “I believe!”
It should be abundantly clear by now, to even the slowest among us, that the promise that 95% of Americans wouldn’t see their taxes raised by one dime during an Obama administration was a flat out lie.
Of course, given the promise of health care and the cap-and-tax proposal pushed by candidate and now President Obama, the 95% should have been able to figure out the lie well before the election. But they didn’t.
The Heritage Foundation has laid out the proposed taxes Congress is looking at to fund this 1.5 Trillion “Health Care Reform” legislation being proposed (note: consider this 1.5 Trillion estimate in light of the Medicare estimate back in the ’60s. It was a low ball load of blarney then and I have little doubt that this estimate is a low ball one as well).
Proposed tax hikes in this category[tax the rich - ed.] include: 1) capping the value of itemized deductions including gifts to charities; 2) a 3% surtax on households earning more than $250,000; and 3) a millionaires tax.
But the left is beginning to figure out that you can only squeeze so much revenue from class warfare taxation. So Congress is also considering a slew of other taxes that will, again, force Obama to break his not tax hike promise. These include: 1) a tax on soda; 2) a tax on beer; 3) an increase in employer and employee payroll taxes; 4) a flat tax on health insurance companies; 5) broaden the Medicare tax on investment income; 6) an employer mandate; and 7) a value added tax on everything but food, housing, and Medicare. And we’re sure we missed some.
There’s no other way to “save money on health care” than to tax the hell out of those who will be stuck with the system they cobble together.
Then add cap-and-trade’s impact (and taxes) to the mix and explain how an economy already reeling with a loss of 15 Trillion in wealth is going to recover when more and more of the private sector’s money (and wealth) goes to government?
Colin Powell said that it appeared to him that Americans not only wanted more government services, but were willing to pay for them. Michale Barone, who is probably one of the better poll interpreters out there, looks at a gaggle of them and isn’t so sure Powell is right (Powell has since become concerned with Obama’s expansion of government and spending):
Last month’s Washington Post/ABC poll reported that Americans favor smaller government with fewer services to larger government with more services by a 54 to 41 percent margin — a slight uptick since 2004. The percentage of Independents favoring small government rose to 61 percent from 52 percent in 2008. The June NBC/Wall Street Journal poll reported that, even amid recession, 58 percent worry more about keeping the budget deficit down versus 35 percent worried more about boosting the economy. A similar question in the June CBS/New York Times poll showed a 52 to 41 percent split.
Other polls show a resistance to specific Democratic proposals. Pollster Whit Ayres reports that 58 percent of voters agree that reforming health care, while important, should be done without raising taxes or increasing the deficit. Pollster Scott Rasmussen reports that 56 percent of Americans are unwilling to pay more in taxes or utility rates to generate cleaner energy and fight global warming.
Of course the fun of all this is to try and determine what all of that means. Analysis is then turned into political action – or so it is supposed to go. But the problem is determining what “Americans favor smaller government with fewer services” really means. Like “hope and change” everyone has their own idea of what “smaller government” is, and my guess is it isn’t much smaller than it is now if at all. Instead, poll respondents may be saying they don’t want it to get much bigger.
Probably the most interesting trend in these cited polls is the movement of Independents away from what can only be favoring a big government Democrat. Anyone who actually paid attention to the campaign of Barack Obama and didn’t realize he was a guy who was fully invested in big government and sweeping federal programs shouldn’t have voted.
Reality is here now. All the “hope and change” hoopla has finally boiled down to intrusive and very expensive government programs such as cap-and-trade and health care reform. The election bill is coming due. Yet, if these polls are to be believed, the majority of Americans – while still favoring Obama personally with high approval ratings – are not at all happy with the direction the Democrats are taking the country.
This apparent recoil against big government policies has not gone unnoticed by Americans. Gallup reported earlier this week that 39 percent of Americans say their views on political issues have grown more conservative, while only 18 say they have grown more liberal. Moderates agreed by a 33 to 18 percent margin.
What has driven much of this shift in opinion is the economic downturn and the problem the average American has understanding the huge deficit spending policies of this administration. He certainly understands that the same policies applied to his household would be an unmitigated disaster. So common sense opposes deficit spending, especially at the unheard of levels this administration has committed itself too. Thus far, too, the economy hasn’t responded, and job losses continue unabated. As with all politics, the proof of any policy is in its execution, and the execution of the stimulus has been awful, to be charitable.
That leads to a loss of confidence. But it also leads to a little soul searching on the part of those who’ve agreed, with their vote, to give the Democrats a chance. They’re now beginning to wonder if they made a mistake. The economy is tanking, unemployment is 2.5 points above where they said it would be unless they passed the stimulus, and they’re talking about tacking two monstrous tax and spend programs (cap-and-trade and health care) on top of it all.
No wonder the nation is growing more “conservative”. Of course, again, it is up to the political analysts to try to determine what “more conservative” really means and convert that to votes for their side. I have every confidence that the GOP won’t have a clue how to do either the analysis or the conversion, but these polls seem to indicate that there is a lot for the right to exploit politically. However, distracted by the Palin/Sanford/Ensign nonsense, and without a strong voice to make their case, I’m sure they’ll miss this opportunity completely.
That’s not to say the Democrats won’t self-destruct as they’ve always done in the past, however, Republicans need to rally and stop both cap-and-trade and health care “reform” in their tracks. It seems, if these polls are to be believed, that they have the support of the public. The question is, do they have the ability to form the necessary political coalitions to stop this huge expansion of government in Congress or not? If not, taking it apart later isn’t as easy as one thinks. Very few programs, once passed into law, are ever discontinued at a later date.
However, the unfortunate part is if the GOP does successfully stop this legislation, they’ll be roundly demonized by the left, something the left does very well and the GOP defends against very poorly. Their inclination, then, is compromise. And that means accepting the premise the Dems are floating but trying to make its impact smaller and less intrusive. That, most likely, will be what we’ll end up with – and if so, the GOP will deservedly be tagged as a “bi-partisan” part of the disaster that follows and will have killed their only possible electoral advantage.
If the GOP wants back in this thing, they’ve got to assume Colin Powell was wrong (and the polls seem to suggest that), reject the premises contained in both cap-and-trade and health care reform completely and unify as the “party of smaller and less intrusive government”. That’s how they regain power. To retain it, however, they’ll have to walk the smaller government walk instead of, as they did last time, becoming Democrat-lite. And that’s where they always fail.
We continue to hear how wonderful it is as compared to the horrible US system.
But is it? One of the fundamental truths of any health care system is you have infinite demand meeting finite resources (beds, doctors, availability, etc). Whatever system a country has, that truth doesn’t change.
So, regardless of system, there is going to be some sort of rationing. It is unavoidable and inevitable.
Now add a desire to control and cut costs associated with the provision of health care to the mix (the promise of every one of these government systems). On the one side, as European nations have done, access to health care is expanded to include everyone. On the other hand, these same nations attempt to control health care costs.
The result? Very mixed. France is always held up as the exception to the rule that government health care can’t be both good and inexpensive. But a closer examination seems to indicate that it isn’t an exception at all:
A World Health Organization survey in 2000 found that France had the world’s best health system. But that has come at a high price; health budgets have been in the red since 1988.
In 1996, France introduced targets for health insurance spending. But a decade later, the deficit had doubled to 49 billion euros ($69 billion).
“I would warn Americans that once the government gets its nose into health care, it’s hard to stop the dangerous effects later,” said Valentin Petkantchin, of the Institut Economique Molinari in France. He said many private providers have been pushed out, forcing a dependence on an overstretched public system.
Why have private providers been “pushed out”? Because government has provided health care “cheaper” than do private providers (and obviously at a loss given the deficit). Notice I said “cheaper”. That doesn’t necessarily mean “better”.
And the same thing is being seen in other European health care systems which are considered “models” of government run health care:
Similar scenarios have been unfolding in the Netherlands and Switzerland, where everyone must buy health insurance.
“The minute you make health insurance mandatory, people start overusing it,” said Dr. Alphonse Crespo, an orthopedic surgeon and research director at Switzerland’s Institut Constant de Rebecque. “If I have a cold, I might go see a doctor because I am already paying a health insurance premium.”
Cost-cutting has also hit Switzerland. The numbers of beds have dropped, hospitals have merged, and specialist care has become harder to find. A 2007 survey found that in some hospitals in Geneva and Lausanne, the rates of medical mistakes had jumped by up to 40 percent. Long ranked among the world’s top four health systems, Switzerland dropped to 8th place in a Europe-wide survey last year.
Dr. Crespo’s point is simply an astute observation of human nature. If something doesn’t directly cost the user, why would the user ration the use of such a benefit?
The use, however, still costs someone or something. The doctor must be paid, the institution must be paid, etc. So in the end, the only way to control costs is to cut payments. Eventually, the incentives to enter the health care field become less attractive (unless you like long hours, overrun waiting rooms, minimal time with patients, being second-guessed by a bureaucracy and making much less than a private system allows for compensation) and there are fewer that enter the field. Hospital beds then drop, hospitals merge and there are fewer specialists available to serve the population as Switzerland is discovering.
And then there’s the lack of innovation to face.
Bureaucracies are slow to adopt new medical technologies. In Britain and Germany, even after new drugs are approved, access to them is complicated because independent agencies must decide if they are worth buying.
When the breast cancer drug Herceptin was proven to be effective in 1998, it was available almost immediately in the U.S. But it took another four years for the U.K. to start buying it for British breast cancer patients.
The promise that has been made in the US is health care reform will return the decision making to the doctor. But that’s simply a false promise given the priorities of the reform we’ve been promised. It is to cut cost and make care “affordable” to all. Somewhere is a bureaucracy in waiting which will decide what “affordable” means – and it won’t include your doctor.
So you can expect innovation to begin to slow. Why invest billions when a bureaucracy will decide whether or not it’s a medicine or treatment worth the cost. The same bureaucracy will also decide what it will pay for your innovation. Of course, if the innovator can’t recover the cost of development and make a profit as incentive toward more innovation, the probability exits the developer will simply stop such research.
“Government control of health care is not a panacea,” said Philip Stevens, of International Policy Network, a London think-tank. “The U.S. health system is a bit of a mess, but based on what’s happened in some countries in Europe, I’d be nervous about recommending more government involvement.”
Words of wisdom most likely to be ignored by our legislators here. And the unfortunate thing is it will not only destroy an excellent health care system here, but, given the level of government spending forecast, tank the rest of the economy as well.
[HT: Carol D]
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Subject(s): Honduras, WaPo selling access, health care, Iraq/Afghanistan (withdrawal from cities/new offensive). Oh yeah, and Sarah Palin.
I don’t use the “L” word very often but in this case it seems completely appropriate.
Would a government-run health plan upend the employer-based health insurance system used by 160 million Americans?
The Democrats claim the answer is ‘no’.
Sens. Edward Kennedy, D-Mass., and Chris Dodd, D-Conn., say their plan would preserve employer-sponsored insurance coverage and create an affordable public option for those who need it.
“The … bill virtually eliminates the dropping of currently covered employees from employer-sponsored health plans,” Kennedy and Dodd said in a letter to members of the Health Committee, one of two Senate groups working on health reform.
The bill includes a “pay or play” provision that would require employers to provide adequate coverage for their workers or subsidize a system that will.
“Pay or play” would require companies to pay the government $750 per full-time worker per year ($375 for part-timers) if they don’t offer health coverage, or if they offer “qualified” coverage but pay less than 60% of workers’ premiums. Small businesses that employ fewer than 25 workers would be exempt.
The Congressional Budget Office, which analyzed the legislation, estimated that by 2019 the same number of workers would be covered by employer-based plans as would otherwise be the case under the current system.
“It tracks what we’re seeing in Massachusetts,” a senior Democratic aide on the Senate Health Committee said on a conference call with reporters.
I’ve put the lie in bold. Why is it a lie? Anyone out there have a $750 a year health care plan? Anyone? I don’t know of a plan for an individual that costs only $750. If there is, then there’d be no reason for any of this nonsense would there?
And Kennedy and Dodd (and the Democrats), the supposed “experts” on health care know that very well. This is pure disingenuousness on their part. This is a blatant attempt to launch a lie to get them past a very important sticking point in the public perception of the bill.
But the average – average – individual health care insurance cost in the US is almost $4,000. And then there’s the cost of administering it.
Hypothetical – you employ 100 people. Let’s say your company pays full health care coverage at the national average (for simplicity sake, assume they all have individual policies). You have two people who administer the coverage at $35,000 each. Your total cost each year to cover your employees is $470,000.
If you pay the federal government $750 per employee a year, your total cost is $75,000. But you can let the two people you’ve had administering your health care program go, saving $71,500 (includes -$1,500 for 2 less employees). Total cost of “pay or play” for you? $3,500 the first year ($73,500 vs. $470,000 every year afterward). In reality, however, it is a net savings of $466,500. You don’t have to be a very good businessman to figure out that one do you?
And remember – these figures only involve “individual” coverage. Family coverage is much more costly, but I see nothing from our two Senate experts which even addresses that. So obviously, the cost of the health care of 100 employees could be vastly more than my simplified example.
No wonder we see corporations coming out now to back this sort of a program. For the vast majority of them, $750 per employee is a huge savings not to mention getting them out of the health care provision and administration business. They’ll pay it gladly. If you like your doctor or your plan, tough beans. You’re going on the government plan. And, of course, the administration will be more than happy to blame your problem on “greedy corporations.”
When they do, just consider the lie and the incentive it provides and then lay the blame precisely where it belongs. Not that it will do you any good where it concerns your present doctor and plan.
Just another step along the road to single-payer brought to you by two lying Senators and backed by the CBO.