There is an article in the New York Times Magazine by an American expat living in Holland about how having the government take more than half your paycheck isn’t as bad as it seems. It’s a pretty good article, and if America is headed in a more social democratic direction (as I fear we may be) then we would do well to look more towards the sensible policies of some more socially democratic countries, rather than the sort of populist demagoguery that is sometimes popular on the American left.
Anyway, what caught my eye in this piece in particular was the following bit:
The Dutch are free-marketers, but they also have a keen sense of fairness. As Hoogervorst noted, “The average Dutch person finds it completely unacceptable that people with more money would get better health care.” The solution to balancing these opposing tendencies was to have one guaranteed base level of coverage in the new health scheme, to which people can add supplemental coverage that they pay extra for.
Note that the third sentence contradicts the second. The Dutch find it totally unacceptable that the rich should get better health care than everyone else; that’s why they designed their system so that the rich could get better health care than everyone else. Continue reading
Last week I was accused of being a stooge for the powerful. It wasn’t the first time, and it probably won’t be the last. What did I say that caused this charge? I suggested that the market should be given a greater role in the provision of health care.
Well, then, you might say, what more need have we of witnesses. Everybody knows that free markets are in the interests of the powerful. That’s why big businesses are so opposed to government intervention in the economy.
Changing the subject completely, I was reading an article in the DC Examiner only a few hours later when my eyes fell upon the following sentence:
Philip Morris, openly and without qualification, backs Kennedy’s and Waxman’s bills to heighten regulation of tobacco.
In the LA Times, Ezra Klein extols the advantages of Britain and Canada’s healthcare systems as against the American system:
Britain and Canada control costs in a very specific fashion: The government sets a budget for how much will be spent on healthcare that year, and the system figures out how to spend that much and no more. One of the ways the British and Canadians save money is to punt elective surgeries to a lower priority level. A 2001 survey by the policy journal “Health Affairs” found that 38% of Britons and 27% of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5%. Score one of us!
Well, sort of. American healthcare controls costs in another way. Rather than deciding as a society how much will be spent in the coming year and then figuring out how best to spend it, we abdicate collective responsibility and let individuals fend for themselves.
Writing at Econlog, Arnold Kling takes issue with the claim that Americans are left to fend for themselves when it comes to health care. But whether or not this is how America deals with healthcare costs, it is how we control the costs of lots of other things. Like food. Continue reading
Readers are most likely familiar with Rahm Emanuel, President Obama’s chief of staff (he of the Chicago Way). Some of you may also know that Mr. Emanuel’s brother, Ari, is reportedly the basis for the character Ari Gold from the T.V. series Entourage.
It turns out there is also a third brother, Ezekiel Emanuel. He is to all appearances a bit more low key than the other two. Having obtained an MD and PhD in political philosophy and a degree in chemistry from Oxford, Mr. Emanuel spends his time penning books and articles opposing assisted suicide and explaining how to use vouchers to achieve universal health care.
Oh, and he’s also just been appointed an advisor to President Obama on health care policy. The whole thing is like something out of a Wes Anderson movie, absent the dysfunction.
The state is trying to shut down a New York City doctor’s ambitious plan to treat uninsured patients for around $1,000 a year.
Dr. John Muney offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs.
His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.
But his plan landed him in the crosshairs of the state Insurance Department, which ordered him to drop his fixed-rate plan – which it claims is equivalent to an insurance policy.
Muney insists it is not insurance because it doesn’t cover anything that he can’t do in his offices, like complicated surgery. He points out his offices do not operate 24/7 so they can’t function like emergency rooms.
The Obama administration is signaling to Congress that the president could support taxing some employee health benefits, as several influential lawmakers and many economists favor, to help pay for overhauling the health care system.
In television advertisements last fall, Mr. Obama criticized his Republican rival for the presidency, Senator John McCain of Arizona, for proposing to tax all employer-provided health benefits. The benefits have long been tax-free, regardless of how generous they are or how much an employee earns. The advertisements did not point out that Mr. McCain, in exchange, wanted to give all families a tax credit to subsidize the purchase of coverage.
At the time, even some Obama supporters said privately that he might come to regret his position if he won the election; in effect, they said, he was potentially giving up an important option to help finance his ambitious health care agenda to reduce medical costs and to expand coverage to the 46 million uninsured Americans.
As I noted at the time, many of Obama’s economic advisers are big supporters of removing the tax deductible nature of employer based health insurance, so perhaps this shouldn’t be that much of a surprise. Continue reading
Firing handguns can be difficult for folks with arthritis, as the recoil puts a good deal of stress on the wrist and hand joints, and squeezing the trigger can be impossible. Constitution Arms of Maplewood, New Jersey has created the pictured Palm Pistol, a double action 9mm single shot that supposedly is easier to control than traditional pistols by people with bad hands.
The lame duck period of any politician’s career can be a revealing time. So long as a politician faces the prospect of re-election, there will always be suspicion that his actions are less a reflection of his true beliefs than they are of what he calculates will be to his political advantage. Once the specter of re-election is removed, however, a politician becomes more free to let his true convictions (or lack therefore) show forth. History provides numerous examples of this. And now we have another:
A last-minute Bush administration plan to grant sweeping new protections to health care providers who oppose abortion and other procedures on religious or moral grounds has provoked a torrent of objections, including a strenuous protest from the government agency that enforces job-discrimination laws.
The proposed rule would prohibit recipients of federal money from discriminating against doctors, nurses and other health care workers who refuse to perform or to assist in the performance of abortions or sterilization procedures because of their “religious beliefs or moral convictions.”
It would also prevent hospitals, clinics, doctors’ offices and drugstores from requiring employees with religious or moral objections to “assist in the performance of any part of a health service program or research activity” financed by the Department of Health and Human Services.
In a recent speech, Pope Benedict addressed the subject of organ donation:
If we turn our gaze to the entire world, it is easy to confirm the numerous and complex cases in which, thanks to the technique of organ transplantation, many people have overcome extremely grave illnesses, and in them the joy of life has been restored. This would never have happened if the commitment of the doctors and the competence of the researchers had not been able to count upon the generosity and altruism of those who have donated organs.
Unfortunately, the problem of the lack of available vital organs is not a theoretical one, but a considerably practical one; one can see this in the long waiting list of those whose only hope for survival is linked to the small number of non-useful donations.
Regarding the technique of organ transplants, this means that one can only donate if this act doesn’t put one’s own health and identity in serious danger, and if it is done for a valid moral and proportionate reason. Any reasons for the buying and selling of organs, or the adoption of utilitarian and discriminatory criteria, would clash in such a way with the meaning of gift that they would be invalidated, qualifying them as illicit moral acts. Abuses in transplants and organ trafficking, which frequently affect innocent persons, such as children, must find the scientific and medical community united in a joint refusal. They should be decidedly condemned as abominable.
Under the health care plan offered by Senator McCain, the tax deduction for employer provided health insurance would be dropped, and replaced with a $5000 tax credit for individuals. Writing for Forbes, Obama advisers Brad DeLong and David Cutler are unsurprisingly not fans of the McCain plan:
Republican presidential nominee John McCain believes that the central problem in health care is that people have too much insurance and, because of it, consume too much medical care. McCain seeks to reform the health care system by taxing and punishing businesses that offer employer-sponsored insurance. Once they are forced to drop coverage, he holds, their workers will find themselves in the non-group health insurance market, where they will buy less generous plans and go to the doctor less often. Modest tax credits would help some, but nowhere near all, of the uninsured afford coverage.
Not everyone, however, shares such a negative view of the plan’s major elements:
The most promising way to move forward in all three dimensions – coverage, cost, and long-run fiscal situation – is to replace the employer exclusion with a tax credit, a step that has been proposed many times before (e.g., Butler 1991 and Pauly and Hoff 2002). Firms would still be allowed to deduct the cost of their contributions to employee premiums, just as they can deduct wages and other expenses today for the purpose of calculating taxable income. But workers would now have to include employer contributions to health insurance in their earnings for the purpose of calculating taxes (precisely which taxes is discussed below). In exchange for, workers who purchased qualifying insurance would get a refundable tax credit. Qualifying insurance would be along the lines proposed by the President in his standard deduction for health insurance, including limits on out-of-pocket payments, coverage of a general range of medical care, and guaranteed renewability by the provider (Treasury 2008).
Mr. Furman used to portray the current system as regressive, inequitable and a subsidy for health plans that insulate consumers from the cost of their care, thus inflating health spending. When he was director of the Brooking Institution’s Hamilton Project, Mr. Furman outlined a health reform — again using tax credits — that took the “sensible approach” of “exposing individuals to the price of health care through greater cost sharing.”
When President Bush unveiled a health reform similar to Mr. McCain’s in 2007, Mr. Furman co-authored a Tax Policy Center paper that called it “innovative and a step in the right direction.”
Okay, so Obama’s top economic adviser favors some of the major elements of the McCain health plan. He’s got to be an anomaly, right? Well, not quite:
“Health insurance is not something that is made better by tying it to employment. As a result, essentially all economists believe that universal coverage should be done outside of employment.”
That passage comes from [David] Cutler’s 2004 book, “Your Money or Your Life,” which outlined a strategy for universal health care. Not surprisingly, Professor Cutler’s plan, like Mr. McCain’s, also applied subsidies such as “tax credits — people get a lower tax bill, or a refund from the government, to be used to purchase insurance.”
And here is a post from Brad DeLong’s blog, describing his ideal health plan. Like McCain, DeLong’s plan would contain “[n]o deduction for employer-paid health expenses.” DeLong would differ with McCain, however, in that instead of offering a tax credit, he would require 15% of a person’s income to go into an HSA (with another 5% going to the IRS as a tax increase), with government picking up the tab for medical expenses over that amount. As he explains it:
Why the 20%? Because I am very impressed by the use of technology to drive the cost reductions–which means the reductions in doctor and nurse time: the increases in the number of procedures that a given treatment unit can perform, and thus in the number of people whom we can, collectively, treat–in beneficial-but-optional areas like eye surgery and lenses. It does seem to matter that consumers are cost conscious and economize when they have financial skin in the game. This is the mother of all Health Savings Account proposals.
This isn’t the first time that Senator Obama’s campaign promises haven’t matched up with his adviser’s positions. One wonders, though, whether he has shifted his positions due to their advice nearly as much as they have shifted theirs in order to give it.
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