Republicans for National Health Care

Glad to see that Half Sigma is on board:

Half Sigma: Republicans should support socialized medicine
The current system sucks. It’s not free market medicine. No sector of the economy is more heavily regulated than medicine. For the typical working American, it’s almost as if medicine is socialized. Your healthcare plan is chosen by someone else, your employer. No matter how many healthcare services you consume, it doesn’t cost you any extra money (or only nominally more money). The government is already paying for part of your healthcare in the form of a tax break.

More:

Socialized medicine would be a government benefit that helps the middle class. Poor people already get free healthcare in the form of Medicaid and free emergency care whenever they show up at a hospital emergency room. Old people get nearly free healthcare in the form of Medicare. Fully socialized medicine would merely give middle class wage earners some government benefits for the taxes they are already paying.

Would people still want to go to medical school under the new plan? Yes, because the government should provide free medical school education for anyone who qualifies. If doctors get paid the highest salary in the GS system, which is around $150,000 per year, there will be a lot of takers. Also, we can institute reforms here, such as combining medical school with undergraduate school in order to accelerate education and lower costs. Anyway, doctors aren’t really the system’s biggest cost.

I’ve previously pushed for national health care and national insurance on this blog. It’s the free-market thing to do!

16 thoughts on “Republicans for National Health Care”

  1. I read this for the first time this weekend (remembered glancing at it via TDAXP for some reason) and the argument is very strong, especially with the variety of short and long term benefits it would bring (especially shutting down the medical malpractice industry).

  2. Eddie,

    Thanks for the comment!

    Hopefully we get comprehensive immigration reform next year. and increased visas to medical professionals will be made available, as well.

    Half Sigma’s point about the de facto socialized state of medicine is right-on. Likewise, one reason that I opposed the Bush-Pelosi bailout [1] but support the Soros plan to buy stock in large financial institutions [2] is that the Bush-Pelosi plan itself brings all the rent-seeking harm of socialism, with none of the benefits.

    [1] http://www.tdaxp.com/archive/2008/09/26/the-bush-pelosi-bailout.html
    [2] http://www.tdaxp.com/archive/2008/10/02/political-corruption-the-bush-pelosi-bailout-and-the-soros-plan.html

  3. National Health Insurance for all is a good idea.

    There are positive externalities: More entrepreneurial risk taking, more labor, flexibility, less business distraction all lead to higher long-term growth rate.

    The trick is how to do this.

    The characteristics should be something like this:

    – baseline of coverage should be catastrophic coverage
    – income tax credit that is the same as the catastrophic coverage
    – You can purchase more coverage or pre-paid services if you want
    – employers can offer plans if they want (why would they though unless they are a health care provider anyways)
    – open up providers: let them cross state lines, let govs open up their palns if they want
    -cover pre-existing conditions
    – As a transition…let anybody buy into the federal health plan
    – tax any employer provided health benefits

    This is not a complete health care lower cost reform idea. That would include things like more Physician Assistants and Nurse Practitioners and the like.

  4. Purpleslog,

    I like the way you think.

    Perhaps a compulsory purchase of something at least as good as the federal plan – or even compulsary purchase of the federal plan, with existing private insurance becoming add-ons, would be wise. The ‘purchase’ could be done through the tax-code, or be subsidized in some other way to make sure it is not a tax on the poor.

  5. Sure, the post addresses the very real problem of ‘will people choose to become doctors.’ What it doesn’t address is, what about all the people who are just now becoming doctors? Under this kind of system, they would get screwed royally. So then you have to add in the cost of forgiving the outstanding loans of pretty much every doctor in the US. And then the costs get staggering.

  6. Will,

    Thank you for your comment.

    A similar argument could have been made against a program against our free-trade programs with Japan, with respect to auto workers. What about those who had just joined the union, and so had been planning to enjoy the benefits of that industry, but lacked seniority and experience?

    The medical profession is coddled by one of the largest unions in the country (the American Medical Association), which limits the supply of doctors and hence increase the salary of doctors.

    As medicine is subjected to science and mathematics [1,2] the skill required for many doctors will of course go down, as their gut becomes less important than following best practices.

    [1] http://www.newsweek.com/id/187006
    [2] http://science.slashdot.org/article.pl?sid=09/03/01/2224207&from=rss

  7. Easier way to deal with the problem–the government could take over paying for everyone’s medical school and pay off the medical school loans of existing doctors. Scratch one money problem.

  8. South Dakota has scholarships for teachers and nurses who stay in the state for a number of years. These programs pay off the tuition costs over time.

    Something similar for doctors — as well as increased medical immigration – probably would be a good thing.

  9. Interestingly, it seems that only Democrats ever couch the universal/national health care benefits to our economy in terms of how much of a burden it would relieve on business generally. If business were relieved of the burden of providing health insurance, trickle-down would actually work like it should. Beyond benefits to large employers, small employers would be able to retain their employees (thus encouraging competition in the marketplace) and individuals would be less reluctant to start new business ventures. After all, so many people stay at their jobs not because they want to, but because the health care provided by the company is a necessity.

    As stated in this post, the only people getting shortchanged by the current system is the middle-class. An unfortunate turn of health could, and many times does, completely bankrupt the uninsured middle class. For those in poverty, there is little incentive to reach for the middle class if they are going to lose their healthcare. Obviously, this is contrary to the best traditions of the Republican Party.

    Individuals are still going to enter the medical professions for the same reason that people continue to become lawyers even though the pay is not as glamourous as others think: it is prestigious. And perhaps, they actually want to be doctors. Besides, aren’t these the kind of people that we want caring for us anyways?

  10. SDLawDog,

    Thank you for your comment.

    I agree with your first paragraph.

    I am not sure what you mean by the second paragraph. The health care available to the poor is both (a) expensive for society to produce and (b) not particularly helpful to the poor. obtaining a professional job with health insurance, under the present system, is much better than having to rely on the emergency room.

    Your third paragraph is even poor puzzling. You are pushing two ideas, both of which make little sense. The first is that the rate at which people enter the medical professional, and the prestige the medical profession has, are independent of salary. Especially considering the burden of medical school loans, this seems unlikely! The second point is that professionals who would leave if they were paid less are a net-detriment to a profession. Really? By that logic, let’s cut all science funding that goes to salaries, assistantships, etc!

    In conclusion, your comment started off strong, but made less sense the longer it continued.

  11. Dan
    I’m generally sympathetic to the argument that separating health benefits from employment would make the economy more dynamic and resilient. Charles Krauthammer had a great piece on this in the WAPO this morning. [1] Along with broad reforms in medical malpractice insurance, Krauthammer suggests helping people purchase health care by:

    (2) Real health-insurance reform: Tax employer-provided
    Health-care benefits and return the money to the employee with a government check to buy his own medical insurance, just as he buys his own car or home insurance……

    He also states that:

    ……The health-care benefit exemption is the largest tax break in the entire U.S. budget, costing the government a quarter-trillion dollars annually. It hinders health-insurance security and portability as well as personal independence. If we additionally eliminated the prohibition on buying personal health insurance across state lines, that would inject new and powerful competition that would lower costs for everyone.

    Half S’s idea is pretty idealistic in my opinion. He’s assuming a lot of large bureaucracies can be rebuilt from the ground up (medical school and even undergraduate education) and also assuming that the medical profession would continue to attract top talent if the salary was limited to 150k a year. I think we’d just wind up with a lot more people getting PhDs and going into medical research instead of getting MDs.

    [1] http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080602933.html?hpid%3Dopinionsbox1&sub=AR

  12. Brent,

    Great comment!

    The current system of taxing health coverage is nonsensical. Before Reagan, all spending on health insurance (by individuals and companies) was tax-deductable. He needed a way to lower marginal rates, however, so he gave that up for individuals.

    Now we have a corporat welfare plan.

    I have a feeling that Half Sigma’s ideas for America’s economic system are radical. He is better as a critic than he is as a proponent.

  13. I wish to explain what I meant by my August 6 post regarding the disincentive that exists in many of the poor to move past their current situation. First of all, I suppose that I was contemplating those receiving Medicaid when I referred to the poor “losing coverage.” I realize that not all poor are entitled to be on Medicaid, but certainly a large percentage of those in poverty are indeed a recipient of that program. Furthermore, even if they are not on Medicaid, many poor people do show up in the emergency room for treatment, and since, as a general rule, they are judgment proof, this method does serve as a kind of coverage (albeit inefficient and costly to the rest of us). Therefore, what I meant by losing healthcare is that those who are on Medicaid would be kicked off of it if they started to work, and those who do not otherwise qualify for Medicaid would lose the ability to go into an ER without any financial repercussions. And so, for someone to make the leap from being covered under this inefficient system to a job with no coverage at all is a disincentive. There is even some disincentive in moving into a job with health coverage, as employment is almost never guaranteed, and so goes one’s coverage.

    I stand by my third point: most individuals do not undertake any profession based purely on earning potential. As an attorney myself, I am sure that I could make more money doing something else, however I doubt I would like doing that something else as much. I realize that money is a large part of the equation, but it is not the only important thing about a career. Most doctors are doctors because they want to be, not because it is the highest paying job. I do believe that we would be better off to filter out doctors who are mercenary with regards to their profession. The difficulty is that doctors are not paid and retained based on their performance. Instead, they are paid for performing a service irrespective of the result. Under most current healthcare plans, people are not allowed to switch to an out-of-network doctor if they do not think their doctors are competent. Therefore, until we have true choice of which doctors to choose, only those that truly want to be physicians should be engaged in such a practice.

  14. SDLawDog,

    Thanks for the comment!

    I agree with your view on poverty & socialized medicine. Thanks for the clarification!

    I agree that earning potential is not the most important attribute of a job for most people. But it is an important attribute for many people, which is enough here. One native South Dakotan to another, we see generation after generation of young people leave our state because of an inability to provide high-paying jobs to them. Incentives matter.

    I agree that a reform of how doctors are paid would be useful. A sort of ‘medical fed,’ along with scientific evidence-based medicine, will be needed.

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