Thursday, October 23, 2008

Health Care, Elections, and Media -- Oh My!

I was trying to learn more about the McCain health care plan today and I ran across this article.  Now, I'm not a professional writer like Paul Krugman by any stretch of the imagination, but I did stay in a Holiday Inn last night, and I have had several articles published in peer-reviewed professional and academic publications.  As such, most of the writing I have done requires a certain factual basis even to be considered for publication.  Data must be presented within certain statistical confidence or your manuscript will be tabled and you'll be sent back to the drawing board.  That's why I am so offended by the type of writing Paul Krugman managed to publish in the New York Times on April 6th of 2008.

The whole thing starts out like this:

Elizabeth Edwards has cancer. John McCain has had cancer in the past. Last weekend, Mrs. Edwards bluntly pointed out that neither of them would be able to get insurance under Mr. McCain's health care plan.

Now, while Elizabeth Edwards is a very smart lady, I've yet to find any evidence of her expertise in the fields of health care and insurance. So, my interest piqued by these strong claims, I read on looking for the evidence that Mrs. Edwards was correct.

It's about time someone said that and, more generally, made the case that Mr. McCain's approach to health care is based on voodoo economics -- not the supply-side voodoo that claims that cutting taxes increases revenues (though Mr. McCain says that, too), but the equally foolish claim, refuted by all available evidence, that the magic of the marketplace can produce cheap health care for everyone.

Well, beyond the fact that Mr. McCain is actually Senator McCain and beyond the obvious argumentum ad hominem, I still see no evidence to support Mrs. Edwards's claim yet. Furthermore, at this point, I am also looking forward to any "available evidence" that a free market won't produce cheaper products for the largest number of people. You probably noticed that I changed the quote a little (at least you should have; I did mark my changes in bold). First, I'm not looking for "all available evidence," because I'm certain Paul didn't really mean "all;" that would be absurd. I'm also looking for positive results for the greatest number, because looking for results for "everyone" would also be absurd. Finally, I replaced "healh care" with "products" because the economic principles which have undergone extensive academic investigation for decades apply to most products including insurance and health care.

As Mrs. Edwards pointed out, the McCain health plan would do nothing to prevent insurance companies from denying coverage to those, like her and Mr. McCain, who have pre-existing medical conditions.

The McCain Campaign believes that "no American should be denied access to quality and affordable coverage simply because of a pre-existing condition," and they have a plan to address it:

As President, John McCain will work with governors to develop a best practice model that states can follow – a Guaranteed Access Plan or GAP – that would reflect the best experience of the states to ensure these patients have access to health coverage. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level.

At this point, evidently Paul turned to the McCain campaign for answers.

The McCain campaign's response was condescending and dismissive -- a statement that Mrs. Edwards doesn't understand the comprehensive nature of the senator's approach, which would harness "the power of competition to produce greater coverage for Americans," reducing costs so that even people with pre-existing conditions could afford care.

Mrs. Edwards almost certainly doesn't understand the comprehensive nature of the senator's approach. That's not condescending; it's a reasonable assumption. Further, if Mrs. Edwards did understand the comprehensive nature of the senator's approach, she probably wouldn't be claiming that she would be unable to get insurance. That's not to mention the fact that it's almost wholly unreasonable to suggest that Senator McCain would enact a policy that precludes himself from getting insurance as well.

It also doesn't strike me as particularly dismissive. Paul did, in fact, manage to get a valid and reasonable quote. I suppose, perhaps, the McCain campaign who responded to Paul's questions may have recommended that Paul visit the campaign website ( for answers to Paul's specific questions about pre-existing conditions, but I hardly see that as dismissive; all of the information is there and is freely available.

This, however, is condescending and dismissive; well done Paul:
This is nonsense on multiple levels.

And it goes on . . .

For one thing, even if you buy the premise that competition would reduce health care costs, the idea that it could cut costs enough to make insurance affordable for Americans with a history of cancer or other major diseases is sheer fantasy.

Again, Paul, begging the question. Your premises are as follows:

  • Elizabeth Edwards and John McCain could not get health care coverage due to pre-existing conditions

  • Other people with pre-existing conditions could not get health care coverage

  • If people with pre-existing conditions can get health coverage, it would be cost prohibitive

You are trying to argue that Senator McCain's health care plan won't work because these premises are true, but your only argument to support these premises is that Senator McCain's health care plan won't work. It's almost textbook petitio principii.

Beyond that, there's no reason to believe in these alleged cost reductions. Insurance companies do try to hold down "medical losses" -- the industry's term for what happens when an insurer actually ends up having to honor its promises by paying a client's medical bills. But they don't do this by promoting cost-effective medical care.

Paul, don't attack the term "medical losses" please. They have to have some kind of succinct description to put on their income statements. They also call them "medical costs" sometimes. In either case, it does a decent job of differentiating them from, say, operating costs. On top of that, don't imply that insurance companies try not to honor their commitments as though the entire industry is designed to cheat people and line pockets. Think of the countless lives which have been saved and improved with thanks due to the excellent medical care paid for by insurance companies. Sure, insurance companies can be troubling to deal with, but that's because they also feel like it's unreasonable to pay 200 dollars for 2 Tylenol at the local hospital. They're fighting to keep costs down too, and rest assured that medical providers do cut prices to accommodate insurance companies. I may be wrong, but it sounds a lot like promoting cost-effective medical care.

So, Paul, how are they trying to keep costs down?

Instead, they hold down costs by only covering healthy people, screening out those who need coverage the most -- which was exactly the point Mrs. Edwards was making. They also deny as many claims as possible, forcing doctors and hospitals to spend large sums fighting to get paid.

I know a lot of unhealthy people who have insurance Paul. I don't consider unhealthy people to be healthy. Therefore, I am forced to reject your hypothesis that insurance companies only cover healthy people. As such, I must also reject your hypothesis that this is the way insurance companies cut costs. Further, I object to your claim that insurance companies deny as many claims as possible citing a lack of industry expertise. I would, however, be interested in reviewing your data regarding the large sums spent collecting debt. I wonder if these large sums would be smaller sums if medical care prices were more reasonable. I don't suppose you found anything about that in your research.

And the international evidence on health care costs is overwhelming: the United States has the most privatized system, with the most market competition -- and it also has by far the highest health care costs in the world.

Out of curiosity Paul, in your research, did you come across any data as to the quality of health care around the world? Waiting periods for appointments? Effectiveness of treatments? Life expectancy? Et cetera? Our health care costs are high and we do get what we pay for.

Yet the McCain health plan -- actually a set of bullet points on the campaign's Web site -- is entirely based on blind faith that competition among private insurers will solve all problems.

Paul, it is very interesting (and telling) that you believe that the McCain health plan is a set of bullet points on the campaign web site? Most people would look at such a thing and presume that the bullet points on the campaign web site are actually a succinct summary of the health plan rather than the plan itself. It's also interesting that you believe that the entire McCain staff hasn't considered any research in the design of their health care plan. There are a lot of politicians I don't care much for and there are even more with whom I have fundamental political and social disagreements, but there are very few whom I believe are stupid. Not one of the candidates in this election would dare decide such a critical issue on "blind faith" and it is appalling to think that there are people out there who believe they would, let alone who would publish this belief.

You say potato, I say potahto. You say tomato, I say tomahto. You say "blind faith," I say "decades of economic research." Let's call the whole thing off!

I'd like to single out one of these bullet points in particular -- the first substantive proposal Mr. McCain offers (the preceding entries are nothing but feel-good boilerplate).

That's Senator McCain Paul. You may disagree with him, but he is still a United States Senator and a patriot. Try to be at least a little respectful.

As I've mentioned in past columns, the Veterans Health Administration is one of the few clear American success stories in the struggle to contain health care costs. Since it was reformed during the Clinton years, the V.A. has used the fact that it's an integrated system -- a system that takes long-term responsibility for its clients' health -- to deliver an impressive combination of high-quality care and low costs. It has also taken the lead in the use of information technology, which has both saved money and reduced medical errors.

This is absolutely true. The VA Hospital system has made great strides to catch up to the rest of the health care industry. The VA Hospital is on the cutting edge of technology for a government institution. In fact, the VA is almost as good as privatized health care organizations. Thanks are due not only to the Clinton administration, but also to the Bush administration for "nearly doubling the VA budget, expanding community grants for homeless veterans, signing concurrent receipt legislation and investing millions of dollars in traumatic brain injury and psychological disorder research" according to the VFW newsletter.

Sure enough, Mr. McCain wants to privatize and, in effect, dismantle the V.A. Naturally, this destructive agenda comes wrapped in the flag: "America's veterans have fought for our freedom," says the McCain Web site. "We should give them freedom to choose to carry their V.A. dollars to a provider that gives them the timely care at high quality and in the best location."

Senator McCain has voted throughout his career to ensure that Veteran's Affairs health care programs get funding. Did we look at the same web site? The one I looked at had a pretty long list of things Senator McCain would like to do to support the VA. While I agree that the "freedom fighters should be free to chose" thing is a bit cheesy, I don't see what's wrong with telling our veterans, "hey, go to the VA if you'd like . . . especially for really big and important things, but feel free to go anywhere you wanna go and we'll still pay for it." Not only does Senator McCain intend to leave the VA intact, he would also like to extend VA privileges to retired veterans who aren't even eligible for VA health care. I rest assured that the VA will still be "mantled" when Senator McCain is president, though I encourage you to find out for yourself.

That's a recipe for having healthy veterans drop out of the system, undermining its integrated nature and draining away resources.

It's going to cost money if healthy veterans don't go to the doctor when a doctor isn't needed? I don't follow.

Mr. McCain, then, is offering a completely wrongheaded approach to health care. But the way the campaign for the Democratic nomination has unfolded raises questions about how effective his eventual opponent will be in making that point.

It's Senator . . . ah, forget it. You probably don't use official titles for anybody I bet. I guess I'll quit harping on you for that one Paul.

Indeed, while Mrs. Edwards focused her criticism on Mr. McCain, she also made it clear that she prefers Hillary Clinton's approach -- "Sen. Clinton's plan is a great plan" -- to Barack Obama's. The Clinton plan closely resembles the plan for universal coverage that John Edwards laid out more than a year ago. By contrast, Mr. Obama offers a watered-down plan that falls short of universality, and it would have higher costs per person covered.

I know I promised I'd stop, but it's Senator Obama. Let's try it together: Senator Clinton, Senator McCain, Senator Obama.

Worse yet, Mr. Obama attacked his Democratic rivals' health plans using conservative talking points about choice and the evil of having the government tell you what to do. That's going to make it hard -- if he is the nominee -- to refute Mr. McCain when he makes similar arguments on behalf of such things as privatizing veterans' care.

Yeah, and how absurd to believe that most people are clever enough to make their own choices. I'd have finished this post hours ago had I not spent so many hours laughing aloud at the thought of allowing people to have choices. Next thing you know, they'll want to invest their own money or, ha, could you imagine . . . vote on who should be president! Oh, oh, here's a good one . . . what if I chose to never read the New York Times again because they publish drivel? Choice. Pftt. Could never happen.

Still, health care ought to be a major issue in this campaign. I wonder if we'll have time to discuss it after we deal with more important subjects, like bowling and basketball.

I'll admit . . . I don't get the reference, but I sincerely hope it is a reference to something meaningful and controversial because it sounds trite. I've spent an entire blog post admonishing your lack of factual foundation in your writing so perhaps, Paul, I'll give you the benefit of the doubt on this one. The last sentence here isn't a mere potshot because someone was talking about bowling and basketball when you felt like they weren't paying quite enough attention to you.

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