Is Obamacare A Promise Of Something For Nothing?
Posted by Jeffrey EllisSep 11
Via Carpe Diem comes this Thomas Sowell quote:
Even those who can believe that Obama can conjure up the money [to insure millions more people] through eliminating “waste, fraud and abuse” should ask themselves where he is going to conjure up the additional doctors, nurses, and hospitals needed to take care of millions more patients.
If he can’t pull off that miracle, then government-run medical care in the United States can be expected to produce what government-run medical care in Canada, Britain, and other countries has produced– delays of weeks or months to get many treatments, not to mention arbitrary rationing decisions by bureaucrats.
Con men understand that their job is not to use facts to convince skeptics but to use words to help the gullible to believe what they want to believe. No message has been more welcomed by the gullible, in countries around the world, than the promise of something for nothing. That is the core of Barack Obama’s medical care plan.
This might be one of those rare occasions where I at least partly disagree with Sowell. He seems to be implying that uninsured people are receiving no medical care today, so that extending coverage to them would greatly increase the demand for doctors, nurses, and hospitals. In reality uninsured people are already receiving treatment. As Cam pointed out in the comments to this post, hospitals can turn you away for elective procedures if you are uninsured and can’t pay for it yourself, but they cannot turn you away for emergency medical treatment. The uninsured have caught on to this, and go to the ER for medical treatment even of a non-emergency nature. The costs are passed along to the rest of us through higher insurance premiums. Consequently, when coverage is extended to the currently uninsured, the only demand increase will be for elective surgeries and other procedures that the uninsured can’t get through ER abuse.
But the cost increase will be enormous. Those costs currently passed along to us through higher prices do not include the additional layers of government bureaucracy that will be added by Obamacare. And the price of something goes up, as a general rule, whenever the government subsidizes it. So yes, Obamacare is of course a promise of something (health care coverage for everyone) for nothing (”not a dime” of new taxes or increases to the deficit), but not primarily for the reasons Sowell claims.
5 comments
Comment by jess on September 17, 2009
While people in Canada and the UK might have to wait weeks or months for treatments, overall satisfaction with government-run healthcare seems high outside the US. Having worked in healthcare here in the US, I know of many cases where Americans were quickly treated with ineffective drugs, surgeries, or alternative medicine. They continue to seek care until they are pain-free regardless of whether any procedure is proven effective or not.
I’d be interested in knowing exactly how much of the waste to which Sowell refers consists of healthcare providers and patients using a shotgun approach to medicine.
Comment by jess on September 17, 2009
I forgot to comment on the “arbitrary rationing decisions by bureaucrats” that Sowell mentions. Arbitrary rationing seems to be the hallmark of any third-party payer.
Comment by Jeffrey Ellis on September 20, 2009
Jess, I’m not sure about the higher satisfaction outside the US — seems counter to what I’ve heard. But I agree with you that the “shotgun” approach contributes to rising costs, although I believe most economists think the lion’s share is due to the third party system. And yes, we do have arbitrary rationing now but it will only get worse under a government program because they will put stronger caps on costs than private insurance companies are capable of doing. Demand will go up (more people will have coverage), costs will go down (by force), and then, by necessity, supply will not be there to match the demand.
Comment by jess on September 21, 2009
I currently think that stronger caps would be a good thing in order to limit ineffective or redundant tests and procedures. The difficulty is in researching comparative effectiveness of tests and treatments and then implementing controls (just look at the FDA).
Here’s some more information about the UK to help clarify my statement of higher satisfaction outside the US.
“An annual social attitudes report compiled by Britain’s National Center for Social Research and released in January found that satisfaction with the NHS was higher than it had been at any time since 1984.
However, a breakdown shows that while satisfaction with NHS (general practitioners) was high, at 76 percent, satisfaction with inpatient services had dropped, from 74 percent in 1983 to 49 percent now.” -CNSnews.com
It’s interesting to note that the International Society for Pharmacoeconomics and Outcomes Research found that 3/4 of the NHS total budget goes to Primary Care Trusts which prioritize funding for general practitioners and prescriptions.
Upon reflection it seems satisfaction with healthcare is relative to how healthy a person is within his/her system. The UK system seems well designed to keep healthy people satisfied (low costs with good preventative measures in place). The US has much better satisfaction with inpatient care, but healthy people foot the bill with high premiums and taxes.
And you’re right, demand for primary care and elective procedures would go up in a government program. Perhaps we need to hybridize our system with the UKs and allocate more funding(third party reimbursement) to primary care in order to meet the demand.
I’m taking the liberty of combining the comments of “Throwing Money at the Problem” with this post in the interests of brevity and common issues.
You make a good point about the disablement of the free market in response to my post under “Throwing Money at the Problem”. The consumers do seek out low costs to themselves, but they do it through insurance company premiums. There is no consumer interest in knowing how much healthcare actually costs. Our disinterest may be crippling the free market system. More transparency in the industry would help as well.
Comment by Maddog on September 29, 2009
John Lott has an interesting paper titled, “Uninsured Americans vs. Insured Canadians: Who is More Satisfied with Their Health Care?”
The paper concludes, “that the vast majority of uninsured Americans are satisfied with their health care. Indeed, only 2.3 percent of Americans are both uninsured and very dissatisfied with the quality of the medical care that they receive. The paper finds that Canadians are much closer to uninsured Americans than to insured Americans in their satisfaction with their health care.”
At least in Canada Jess’ assumption seems misplaced.
I do not understand the concept of “arbitrary rationing” you discuss above. Nor do I understand rationing to occur in non-government health care in the US. Presumably you are not discussing the rationing that occurs in Medicare in Oregon, which has intentionally created a rationing system to limit costs within the Medicare system. The results in Oregon are predictably odd with one woman being denied chemotherapy for cancer but being offered assisted suicide if desired.
Mark