Saturday, August 8, 2009

Jon Stewart Clobbers William Kristol on Health Care

Watch Jon Stewart shred William Kristol on health care simply by following the logic of Kristol's assertions. The military deserves the better health care that it gets, according to Kristol, more than does the general population. But, as Stewart notes, the military health care plan is run by the government, which Kristol argues can't do the job as well as our private sector system. Game set and match.

Of course, scientifically, this argument was over long ago. By any objective measure, health care in the US is inferior to so-called socialist systems: We have lower life expectancies, higher rates of infant mortality, less satisfaction, and at significantly higher costs. Just choose a WHO statistic and cringe at the nations that outperform us. The opponents of reform have nothing to offer in rebuttal except evidence-free assertions (higher costs from crack babies), misrepresentation about our present system (we don't get to choose our doctors now, the HMO does that), and anecdotes.

The one card Kristol had to play in the above exchange was that the health care the military receives is expensive, but the reason for that is obvious, and essentially the same reason Medicaid and Cobra are so expensive: they cover the worst risks we have. Applied to the entire populace, average costs would be lower. But opponents of health care reform aren't interested in a reasoned analysis of the problem, as Kristol demonstrates by pulling out two favorite canards: pre existing conditions, and rationing.

When someone talks about eliminating preexisting conditions, what they really mean is eliminating an insurance company's ability to turn down a potential new insured on the basis that the insured already has a medical condition qualifying for payment. However, this need is essential: If people were allowed to wait to buy insurance when they were already sick, that's what everyone would do, and the insurance part of the equation would collapse. Insurance, any insurance, depends on the small premiums of the many to pay for the large unexpected costs of the few. With only the few, costs are not mitigated, and needed premiums would skyrocket. It would be like allowing homeowners to buy wind insurance as the hurricane approaches.

The real issue is portability: allowing insureds on a medical plan with their employer to not be treated as a new insured if they change employers, or lose their job. Change that, and the legitimate problems with the pre-existing conditions go away. When someone like Kristol neglects to mention portability and instead makes it sound like the problem is that the big bad insurance companies won't let you wait to buy cancer insurance until after you have cancer, he is demonstrating either gross ignorance or intellectual dishonesty.

Likewise when you hear people like him prattle on about rationing. Any time there is more demand than supply for a commodity, there will be rationing. It's just brute arithmetic: if there are 6 items, and 8 people want them, 2 people are going without (the real-life complexities complicate the argument without altering it meaningfully). The question is not "will there be rationing?" The question is "by what method will we ration?" Our current system does so poorly and expensively. People like Kristol attempt to avoid the legitimate discussion of the problem by implying the problem is created by government. Rationing is part of the equation, whether government is involved or not.

We need an honest debate of the myriad problems we face with our health care system. Our population is aging, and our financial status is poor. The challenge is great, and the situation is only going to get worse. We don't have time to waste on the prattlings of obfuscating twits like Kristol, who, aside from the dubious distinction of predicting the nomination of Sarah Palin, has been pretty wrong about nearly everything lately.


Luke said...

My favorite is that reform opponents will, practically in the same breath, opine that the government never does anything efficiently or effectively, but that private insurers wouldn't be able to compete with a government-run plan. Shouldn't it be easy for private insurers to compete with the government?

You are exactly right about adverse selection being a major issue. The flip side of adverse selection is skimming: insuring only those unlikely to make claims. Both have to be regulated in some way. Insurance is all about sharing risk, and works best when the risk is shared as broadly as possible.

I agree in theory that giving the consumer credit for prior participation is at least a partial solution to adverse selection. (It has to be coupled with regulation to prevent skimming, so that cost differentials come from operational efficiencies. Too, people have to enter into the system at some point, which can get complicated.) In practice, it would be a good first step, but there are an awful lot of unwise or stupid people out there. Everyone from Barak Obama to Suze Orman to Oprah Winfrey could be screaming to buy insurance while young and healthy, and there would still be uninsured people showing up with heart disease or cancer and not much money to pay for treatment. How would you approach that problem? How do you feel about mandated coverage?

ScienceAvenger said...

You got right to the heart of the issue. Until society is willing to let people who make poor decisions die in the streets, any talk of no socialized medicine is disingenuous.

GravityIsJustATheory said...

I haven't been following the US healthcare debate very closely (I'm British, and there's only so many US political issues one can follow), but from what I have seen, I can add another anti-reform argument that strikes me as particularly poor (and either ignorant or deliberately disingenuous), namely repeatedly bringing up examples of how terrible British healthcare (supposedly) is because some treatments are not available on the NHS, or because you have to may have to wait for treatment.

Now, I freely admit that the NHS has some major problems, and I wouldn't recommend you directly copying it even if it was politically feasible to do so (it can probably serve as an example of what not do as often as what to do).

However, this argument completely ignores the fact that private health care is available in the UK as well.

Britain isn't some sort of communist society where only state-run services are legal.

Vernon Malcolm said...

AHEFT shows African American health care has long been rationed by breeding us to limit our lives, so why should we pay for all those boomer pensions we will never benefit from? After all, it was the boomer pensions which caused the market to crash.

ScienceAvenger said...

OK Vernon, I'll bite:

What is AHEFT?

How and who has been breeding blacks? How have they been limiting your lives?

What about boomer blacks?

What's your basis for claiming that pensions caused the market to crash?