AEIdeas

The public policy blog of the American Enterprise Institute

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Discussion: (25 comments)

  1. I do not think the “left” wants expensive health care .. they are cite the lower cost of other countries.

    I also think the “left” understands diversity. They are looking for a floor level for everyone but to certainly allow anyone to buy “up”. They are not after a one-size-fits-all solution.

    OTOH – it’s hard to tell what the “right” really wants since there is no single proposal they support as an alternative other than “the free market” as if what we have right now is the “free market” and we ought not to be tinkering with it!

    If the “right” came up with a proposal that they said would 1. cover everyone and 2. be in the same price range as other OECD countries – they’d get support – from those who currently don’t have it.

    but the folks who already have employer-provided health insurance would be likely opposed if for no other reason a fear that they would be adversely affected until of course they lose their job and join the uninsured….

    there is no way to fix the current system without changes that affect everyone.

    employer-provided health insurance is about as bad as defined benefit pension plans.

    as more and more people who are uninsured seek the ER rooms and MedicAid to pay for their care – those costs are shifted to those with employer-provided insurance and those costs go up every year.

    the “affordability” issue is affecting not only those at the margins but also those with employer-provided health insurance as every bit of productivity gain is being sucked up by increased insurance costs – and the worker gets no increase in pay..it all goes to pay for higher premiums.

    There is no question that ObamaCare is complicated and convoluted – it actually is trying to reform a system that is complicated and convoluted.

    The “right” needs to come up with a better alternative than “just say no”. they need specifics on the table.

    1. I do not think the “left” wants expensive health care .. they are cite the lower cost of other countries.

      The US system is required to waste much more on administration than most countries. And it forces the insured and the taxpayers to pay for very expensive procedures on those that have no insurance even though such procedures would not be approved in most other countries.

      1. ” The US system is required to waste much more on administration than most countries. And it forces the insured and the taxpayers to pay for very expensive procedures on those that have no insurance even though such procedures would not be approved in most other countries.”

        so you don’t think the OECD countries have administrative costs?

        Canada? how about your country?

        re: “not approved in other countries”.

        isn’t that “rationing”?

  2. Statism at its finest…

    1. ” I used to believe that AEI favoured small government. I could not have been more wrong.”

      yup. AEI is as pro-government as any leftist group – just for the things they like… not the least of which is a mega military industrial complex…

    2. statism = one form of elective governance….

      If we agreed to provide a centrally-managed, collective approach to National Defense..

      what keeps people from thinking that same approach could also be used for other things to “help” the country and it’s people?

      the very basis for defending the borders becomes the impetus for using that same approach for other “needs”.

      1. statism = one form of elective governance….

        Try getting a better dictionary that explains what elective means.

  3. Just choose a free market. Let corporations, nurse practitioners, foreign trained doctors, and others compete. Get rid of all the rules that cause so many dollars to be wasted on filling out forms. Get rid of the FDA. Let consumers choose and let them pay for the services that they choose. Health care will be much better once it is delivered in a free market.

    1. there are 150 countries in the world where the govt does not “do” health care.

      perfect laboratories for the free market approach.

      surely if that is the right approach, there are success stories.

  4. You know, it’s easy to say this is “big government” without reading the report. This plan does require governmental action, true. But it also promotes market forces in significant ways by putting the poor into private insurance markets and getting rid of government incentives for employer provided insurance.

    You’re being overly idealistic if you think we can actually have a perfectly free market in health care. The ACA is policy right now. We should be trying to figure out how to change and improve upon what we’ve got, not thinking about pie-in-the-sky abstract ideals.

    This isn’t centrally planned health care. Centrally financed, sure. But the very nature of the plan is that everyone would be privately insured. If you’re going to criticize the report, at least read it. There’s a link in the article…

    1. You’re being overly idealistic if you think we can actually have a perfectly free market in health care.

      You had a pretty good system in the 1960s when government regulations were minor. The uninsured still managed to get care and insurance was not priced at astronomical levels.

      1. free market health care is not some magical nirvana.

        it already exists in about 150 countries in various degrees. that’s the non-OECD countries.

        pick the one you like and we can be like that.

        I don’t buy the govt regulation angle either as all the other OECD countries also have govt regulations and still deliver health care at 1/2 what we do.

        A hip implant in this country is around 80-100K while in regulation-laden Belgium it’s 15K.

        but the opponents of the ACA have no real alternative other than some largely unspecified “free market” that they’d surely deny would be like the 3rd world countries.

        but even among themselves they do not agree on specifics.

        the big mistake everyone makes here is thinking everyone is going to get the same health insurance and care but they won’t.

        It’s like Social Security or Medicare – it’s basic level care. If you want more/better you should get it just like when folks in Canada want more than their basic care will provide, they come to the US to pay for more/better out of pocket.

        The opponents to the ACA appear to be opposed to basic level safety-net type care for everyone and that would explain why they really have no specific alternatives to propose.

        1. I can’t figure out if you’re criticizing this plan, or conservatives generally.

          “opponents of the ACA have no real alternative”

          This plan is an alternative.

          “the big mistake everyone makes here is thinking everyone is going to get the same health insurance and care but they won’t.”

          The staple of this plan is its commitment to diversity of care.

          “The opponents to the ACA appear to be opposed to basic level safety-net type care for everyone”

          Basic safety-net care is what this plan guarantees. It allows for more if people want it.

          1. I can’t figure out if you’re criticizing this plan, or conservatives generally.

            I’m saying that a “plan” is more specific than a philosophy or hypotheticals… it lays out specifics in enough detail that it can be compared and contrasted to other plans.

            “opponents of the ACA have no real alternative”

            This plan is an alternative.

            as I said.. until you can say this plan does that and the other plan does something else.. then it’s not a “plan”.

            “the big mistake everyone makes here is thinking everyone is going to get the same health insurance and care but they won’t.”

            The staple of this plan is its commitment to diversity of care.

            no.. that’s a a statement of philosophy unless you detail how it does that – what it does – what it does not do, how it compares to the ACA – and specifically why it’s better.

            “The opponents to the ACA appear to be opposed to basic level safety-net type care for everyone”

            Basic safety-net care is what this plan guarantees. It allows for more if people want it.

            I do not believe a statement of something asserted without showing the details is a real plan.

            I could come up with a similar alternative and say that my “plan” does diversity better than yours but neither of us have anything to prove our statement other than our claim… that’s not a plan,

  5. Before anyone compares US to other countries one must first understand that when it comes to cancer, heart attack stroke and even that management of hypertension the US data is far superior to everyone else.

    1. Before anyone compares US to other countries one must first understand that when it comes to cancer, heart attack stroke and even that management of hypertension the US data is far superior to everyone else.

      We need to be careful. Say we both are going to die of some form of cancer at age 60. You are tested every year and find the cancer at 45 years of age. I have the same cancer but do not find it until I am 58. You get the treatment and live to be 60. I get my treatment and live until 60. According to the data the US treatment is much more effective because the patient managed to live 15 years while in my country the patient managed to live 2 years. But the effect was exactly the same. We had the same condition at the same time and died at the same time. But because the cancer was not discovered at the same time the country in which it was discovered earlier gets a better grade.

  6. LarryG: This is a couple-hundred word blog post. Read the report. It provides all the details you’re saying the proposal doesn’t have. As I’ve stated, read the report before you criticize it.

    1. re: “read the report”.. I DID read it and there is no way in Hades that “real” Conservatives will support it.

      and that’s my point. this is NOT a proposal from the Conservatives who oppose the ACA.

      the folks that wrote this would be run out of the GOP on a rail…

      1. You’re jumping around a lot to avoid criticism, so let me be explicit. You said that it’s not a plan until it clearly delineates what it does and doesn’t do.

        The report does that.

        You said the plan isn’t compared to the ACA.

        The report does that.

        You said the report doesn’t offer details on how it establishes a basic safety net.

        The report does that.

        All of these details, and plenty more, are in the report linked to above. Just asserting that all this information is lacking doesn’t change reality. Reality is, the report lays out a set of values underlying the plan, it sets out the plan, it explains the hows and whys of the plan, and it compares the plan’s effects to the ACA.

        1. you are correct. but this “report” will NEVER be accepted nor promoted by the current opponents of the ACA.

          this is NOT an alternative being offered BY THE OPPONENTS of the ACA.

          and that’s what I was saying – that the current opponents of the ACA have no alternatives – AND will not adopt this report EITHER.

          am I wrong?

          1. I’d say you must be defining “opponents of the ACA” in an odd fashion to not include the authors of this report or others who advocate for it (the several AEI people who wrote on this report, for example).

            If, by opponents of the ACA, you mean GOP politicians, then I’m not sure. I don’t know of their reaction to this plan at this point in time.

          2. well.. I’m defining the folks who politically oppose the ACA and would likely not accept a single proposal in this report.

            I’m willing to go over the things in it – point by point if you want but my first reading of it made me feel that not a word of this report was written by anyone who is a current active critic of the ACA.

            it’s almost like a Democratic alternative…

            I’m going to go back and re-read the report – just to make sure that my first impression was not wrong but my feeling is that this report was not written by current opponents of the ACA AND that no current opponents of the ACA would back this report as a GOP alternative to the ACA.

            you have to ask – who wrote this report in terms of where they are on the political spectrum – and who did the authors think would take up the report as a politically viable alternative to the ACA.

            I saw this report as running a flag up the flagpole but I was totally not clear on who exactly would salute it.

          3. I do give them credit especially for being courageous enough to tackle employer provided health care which I agree is a huge problem in terms of costs but they also focus on “exchanges” as if the ACA does not do that same thing – with private providers – who also are using risk-based premiums.

            The GOP sees poor people as “takers” and any taxes spent on them as stealing from other taxpayers.

            Strike 1: ” Fourth, we propose to abolish the tax
            preference for employer-sponsored health
            insurance plans. This subsidy encourages
            excess utilization of both insurance and
            low-value health care services. It also costs
            the federal government nearly $300 billion
            in lost revenue—revenue that could be
            used to fund insurance for the sick and the
            poor.”

            strike 2 : Second, to ensure that offers of insurance
            are affordable, we propose government financed
            premium supports. The poor,
            especially the sick poor, gain access to a basic
            insurance plan at no cost and to more generous
            plans at significantly reduced costs.

            Strike 3 – the coup de grace :

            ” One solution to mitigating the debt and deficit
            consequences of high health spending is to raise tax
            revenue to compensate. ….. Therefore,
            the economic effects of taxing everyone to provide
            universal coverage differ from the economic effects of
            a system that generates the same spending but is
            financed through private purchases.”

            Hey.. I GIVE these folks CREDIT for an alternative approach (that STILL USES health care exchanges) AND gets rid of employer-provided tax credits

            but realistically do you really think the GOP – the only other political group involved in health care – is going to sign on to this alternative?

            seriously?

  7. R Richard Schweitzer

    These “proposals are simply another approach to the “transfer of costs” philosophy of social organization. Of course, such other direct approaches to that philosophy have advantages over the perversion of contracts of insurance (which are transfers of risk).

    When we see phrases like “government financed,” it is a soft terminology for cost spreading over the taxpayer base. This is suggested during a time when the actual base of taxpayers is shrinking (it certainly is not growing at the rate of the “need” [demand] for healthcare benefits). The government has no money, does it?

    Under PPACA we are currently dealing with an attempt to force the transfer of costs of healthcare benefits: first, over a base of all persons seeking to provide means for the transfer of risks of needs for healthcare, as well as to provide for general healthcare maintenance through contractual means. To backstop the inadequacy of that base of contractual participants we have begun a legislative process (ACA) of transferring those healthcare costs not otherwise transferred to the contractual participants to the taxpayer base.

    So, let us reassess whether these approaches are “new.”

    Reply

    Leave a Reply

    1. to be honest on transfers though

      1. – tax-free health insurance is a ‘transfer’.

      2. – MedicAid is also a ‘transfer’

      3. – EMTALA is also a ‘transfer’.

      if the premise is that there will be no transfers, and you ignore the current ones… and you could actually reduce the total amount of transfers with a different approach that also reduced health care costs… then the status quo is no good either especially when it eats up 17% of your GDP and ends up being the most expensive health care system – in the world …

      do we stay like we are or do something else?

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