Defending Against Dishonesty

The St. Louis Post-Dispatch wrote a very dishonest op-ed ["Defending the Indefensible"] attacking what they call “opponents of health reform”.  Here is my response that I left for them on their web site:

I guess this is one way to win an argument.

1. Claim that your opponents are arguing for something that they aren’t. Who exactly has put forward a plan that says “Keep everything exactly the way it is now”? Now, given that the makeup of Congress is such that the only plan that could possibly pass would be one that is decidedly more liberal (more apt to allow government control) than conservative, the outcome of the current session would be either a liberal plan or no plan. This does not mean that conservatives wish to maintain the status quo. People like Congressman Paul Ryan have been pushing a conservative option for a few years now.

2. And then quote questionable studies that are influenced by how much government controls health care to determine quality of said system to slime those opponents. What is it that a native son of Missouri used to say about statistics? It’s not all that hard to skew the results to be how you want them when you can control the input variables to favor your outcome.

3. While simultaneously assuming that the problem is really one of health insurance and not the health care industry. The cost of health insurance is a function of the health care market (or this thing that is supposed to be a market but hasn’t been a functioning market since 1965). As health care costs rise, so will health insurance premiums since we incentivize individuals to claim everything under the sun on their insurance plan.

4. Opponents have been making a coherent case. You just aren’t listening. See Rep Paul Ryan of above. See Michael Tanner and Michael Cannon at CATO. See Greg Scandlen. See a brilliant op-ed by Whole Foods’ CEO John Mackey in the Wall Street Journal. Etc.

As to some of the points that you make.

1. Higher administrative costs exist because you are not comparing things that are alike. In other countries, as with Medicare and Medicaid, there are many costs that are not included in their budgets. For example, in the private health care market, insurance companies have to have departments for billing, legal teams, etc that government run entities include in other budgets. The costs of the IRS collecting premiums are not included in the costs of Medicare. Neither is the costs of prosecuting those who commit fraud against the system. The same goes for many other countries. They shift those costs to other departments to make their numbers look better. {Gee, that sounds an awful lot like Enron style accounting to me}

2. Wasteful spending exists for several reasons. First, doctors practice a lot of CYA. They get sued (a lot). The best defense against a law suit is to show that you “did everything you could”. Even if that means ordering tests that have little to no benefit to diagnosis. Second, people bear a small portion of the costs of their decisions. When covered by insurance, the cost difference between an X-ray or an MRI seem quite small. When an X-ray will suffice (which costs far less) many will insist on receiving the MRI because they think it will give better results (at much higher cost). Because of the insurance coverage that they do have, they never see the true impact of that decision.

3. People most assuredly will lose their current coverage under the current proposals in front of congress. Own an insurance plan that is not exchange approved? You can keep it until the company has to alter the plan. Then you are forced to buy a policy from the exchange which is likely to be more expensive than the one you had before. On a company run plan? When faced with the decision between paying you $4000 for your individual plan or $12000 for a family plan versus a $750 fine for not providing insurance coverage, which do you think your employer is going to choose? If you said that they would continue to offer coverage you should be reminded that companies are looking to cut costs everywhere, especially these days. And cutting costs by millions of dollars would just be far too attractive to many companies to ignore.

A topic that you really miss covering here is how the current proposals will lead to a decrease in employee wages. If an employer is required to provide insurance coverage or face a fine, their costs of employing someone are going to go up in either instance if they don’t already offer health coverage. In an environment where wages are already seeing very slow growth, this would shift additional compensation dollars to health care since employers already cannot afford to both increase wages and health care premium contributions at adequate rates. Forcing them to put more into the health care premium contribution means that there will be fewer dollars available for wage increases. In extreme cases, this could even mean a reduction in either wages or number of employees if costs get too far out of hand.

{P.S. Is this reasoned enough debate for you? Or am I just trying to “fear monger” as you have so broadly painted the “anti-reformists”?}

Cross-posted at my personal blog.

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