Saturday, September 26, 2009

Healthcare and Liberal Thought

It has been a while since my last post. Classes started a few days afterwards and have dominated my time outside of work. There have been lots of readings on Metaphysics and Epistemology, which are always tough with so many abstract concepts that must be absorbed. I promised a follow up on The Problem of “Other People’s Money”, but will preempt that for now in order to further refine philosophical views on the healthcare debate. In particular, over the past month, I have continually heard mostly emotional arguments from liberals in favor of government run healthcare or some form of a “public option,” with the arguments generally parroting that of the Obama administration, who argue that the rising costs of healthcare are unsustainable, and thus we cannot continue with the “status quo.” On the former point, I think most of us are aware on both sides of the political spectrum that the current path is unsustainable.  On the latter point, I can’t think of anyone who believes we should continue with the status quo. Somehow, however, Obama, Reid, and Pelosi can’t seem to separate the fact that someone who opposes their proposed solutions can also agree with them on those two points, yet this triumvirate conflates anyone’s opposition to their proposals with a necessary belief that those opposed don’t want to see things change. So far they have continued to repeatedly promote such flawed logic, demonstrating that the era of post-partisan politics has yet to begin.

In my last post, I discussed how charitable giving patterns indicate persuasively that liberals, who are particularly adept at making moral arguments as to why the government should do this or that to stamp out greed and bring equality to the people, give far less of their time or money towards charitable activities, regardless of income, that could actually help the human condition. They simply expect the government to solve all social ills, instead of rolling up their sleeves to help solve problems or opening their wallets to those who will. While there is no direct connection of charitable giving to the debate on healthcare, I would argue that a key relationship is their tacit belief that only government can solve the healthcare problem and that it will actually produce a viable remedy. The moral argument in this case is that everyone has a fundamental right to healthcare, but are being denied that right due to the greed of insurance companies who Obama likes to say are making “record profits” through unnecessarily high premiums. Yet as an industry, health insurance companies have only a 3.3% profit margin, less than the 4.6% average for all businesses in the country, as reported by Karl Rove in a recent Wall Street Journal article.  Rove goes on to note that drug companies enjoy an average 17% profit margin. But even that is less than software companies, which earn a 22% profit margin on average. So Obama is simply wrong on insurance company profits, just as he was wrong when he demonized oil companies for making “windfall profits” during his campaign. Yet I have not seen a single liberal challenge his dishonesty in either case.

I wonder if it has ever occurred to liberals that Medicare and Social Security are both going bankrupt, and that between these two government programs there is over $100 trillion (yes, trillions) in unfunded liabilities. Moreover, we have an unprofitable Amtrak train service and a Postal Service that is always flirting with bankruptcy. Yet they want the government to either take over or control an industry that represents roughly 1/6 of the entire economy? There must be other factors at work here than simply wanting healthcare for all Americans, since it would be foolhardy to believe that government, with its track record of failure, could become a viable and competitive player in health insurance. In fact, government regulations have inhibited competition in the health insurance market, thus contributing to the rising costs of healthcare. State regulations won’t allow insurance to be sold across state lines, so there tend to be monopolies within the states, lessening competition. There is also the need for tort reform so doctors don't pass the high cost of malpractice on to patients or order unnecessary tests playing defensive medicine. Another problem is that corporations get favored tax treatment that small companies and individuals don't enjoy. Further, states impose regulations that put specific mandates on what insurance companies must offer. This is why you can't pick and choose from a menu of choices that could lower your premium, as you can with car insurance. So even though there are a number of relatively simple things that can bring down healthcare costs without the government becoming a player and taking on debt, such commonsense measures aren’t even on the table.

A huge factor in healthcare costs is the personal health choices that people make on a daily basis. Americans smoke, exercise too little, and eat too much. Thus, heart disease and diabetes are contributing to skyrocketing premiums as insurance companies try to cover ever higher costs, particularly as people approach end of life. As well, people demand more and more technology to keep them alive. This costs money and drives up premiums. So how come all of the blame is placed on the feet of the insurance companies, and none at the feet of the insured? Has it been conclusively demonstrated that all or most insurance companies are greedy and systematically bilking the insured? While I don’t believe that case has been made, I am fully aware there are some  insurance companies who attempt to maximize profits through the practice of rescission, and also “cherry-picking” the most profitable customers. Yet rescission is a violation of state laws unless the customer intentionally lied or omitted pertinent medical history. Cherry-picking is something the states should take action on. If an insurance company can bring in someone with a pre-existing condition and keep the actuarial pool integral, they should be required to do so. But they should not be forced to take on all customers, since this could destabilize the pool for all. For those that don’t qualify for insurance, high risk health insurance pools should be made available at the state level (as some states have done), which is a reasonable display of compassion provided by taxpayers.

I haven’t said much new in this post, but have mostly summed up thoughts that I have outlined over the past several posts. What I want to emphasize is that liberals should cease advocating government redistribution of wealth and being paranoid about greed in the capitalist system, particularly when they benefit from our capitalist system as do conservatives, even holding a slight income advantage. Instead of calling on government to do all of the heavy lifting, my admonition is if liberals truly want to make a difference in the health insurance market and are concerned about profits, they should be proactive and start non-profit health insurance companies themselves (which would have the added benefit of creating much-needed private sector jobs), instead of reflexively looking to government. Or instead of swallowing the government’s currently proposed solutions without any thought as to its far-reaching implications, ask what can be done to simply improve the existing system before advocating game-changing legislation that could do tremendous harm while doing very little good. This is not the type of legislation that should be crammed through along party lines, affecting each and every member of society, when the vast majority of Americans are happy with the healthcare system as it is now, but recognize there needs to be sensible reform. What is currently being proposed by the Obama administration and the Democratic-led Congress is far from sensible, if not downright irresponsible. And the rush to legislate only reinforces my belief.


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