Death Panels: Later Rather than Sooner
In a stunning moment of candor, Paul Krugman just gave Sarah Palin, the progenitor of that much derided meme among the Left—the death panel—a tremendous gift. Apparently, liberals were only joking when they were criticizing the “crockpot” idea among conservatives that health care will need to be rationed by ominous “death panels.”
Joel Griffith of Breitbart writes,
Nobel Prize winning “economist” Paul Krugman spoke at Sixth & I Historic Synagogue in Washington, D.C. last week. During the Q&A session following the lecture, an audience member asked him about the rising national debt.
Earlier in the evening, Krugman had already vocalized his satisfaction at President Obama’s apparent lack of concern over the exploding cumulative deficit. However, in a moment of brutal honesty, the esteemed Princeton professor revealed his long term prognosis. According to the professor,
“Eventually we do have a problem. That the population is getting older, health care costs are rising…there is this question of how we’re going to pay for the programs. The year 2025, the year 2030, something is going to have to give…. …. We’re going to need more revenue…Surely it will require some sort of middle class taxes as well.. We won’t be able to pay for the kind of government the society will want without some increase in taxes… on the middle class, maybe a value added tax…And we’re also going to have to make decisions about health care, doc pay for health care that has no demonstrated medical benefits. So the snarky version…which I shouldn’t even say because it will get me in trouble is death panels and sales taxes is how we do this.”
Now, I’m sure some might say that Krugman was just employing some of that deadpan, sardonic “wit” of his here, but call me skeptical. After all, he admitted that his remarks would likely get him into trouble. So, my question is this: Is this another moment of liberalism removing its mask to reveal its chilly indifference to murder? If we want utopia, according to Krugman, we will one day need to start pulling the plug on grandmas and other drags on our medical resources. Ladies and gentlemen, I give you…the conscience of a liberal.
Is is better to A) bankrupt the country with unnecessary procedures B) Allow insurance companies’ own death panels to deny procedures because of profit motives or C) Deny care to people simply because they do not have funds to pay for procedures.
In an Army hospital, if a patient asks for unnecessary procedures, the doctor, who is a government employee, will say no. Is that a death panel?
First of all, my point should have been obvious. Death panels have been derided by liberals as a loony idea, that is, until their great high priest Paul Krugman decided to give death panels his blessing. As for your questions, I think unnecessary procedures are a byproduct of government intervention. The economic term is moral hazard. In my opinion, health care should be deregulated and privatized in order to stimulate competition, reduce costs, and improve quality, which is what happens in any other market sector that allows legitimate competition. In a fallen world, this won’t create perfect outcomes, but, in conjunction with church and charity efforts, I think this is far superior to any government rationed care. As it stands, no one has a right to healthcare, and, thus, a right to bankrupt other taxpayers. However, doctor’s have a responsibility to care for their patients and respect their wishes as long as someone is willing to voluntarily pay or absorb the cost. It’s more just than any other alternative.
If you have doubts, then I recommend this piece I wrote a couple of months back about the mythological superiority of Canadian healthcare.
http://seeingthesword.com/2012/11/30/the-canadian-canard/
I believe you are distorting Krugman’s sarcasm here. In video, the crowd laughed at his dry sarcasm. The whole idea of “death panels” is a joke and he’s treating it that way. What Palin referred to as ‘death panels’ is an advisory board meant to control out of control costs. The government is involved is healthcare whether we like it or not. For those of us that care about government spending, why not try to avoid unnecessary costs?
Which is what I said would be done (i.e. that this was just a joke), but then why did he preface the remark the way he did? And was he joking about raising taxes on the middle class, too? Of course not! I understand that he doesn’t want anything called a “death panel”, per se, but he seems to be conceding that more extreme rationing will soon become necessary. Just a couple years ago, the average wait time for brain surgery in Canada was roughly 9 months. If that’s the kind of excellence we should be striving for, then heaven help us. Now, I’m all about cutting costs, but our health care costs have been accelerated not by market forces, but by government intervention. Medicare’s fee-for-service pay schedule emphasizes volume over quality. The fact that people don’t foot their medical bills leads to overconsumption and a demand for expensive, unnecessary diagnostic tests. Even government is responsible for our doctor shortages, thanks to the caps limiting the number of medical school graduates and medical schools. Government is great at distorting incentives and delivering goods ineffectively and inefficiently, and yet people still hope for the impossibility that more government will result in better service. I don’t get it.
Well you and I certainly agree that Medicare’s fee for service model is stupid.
I would again point you to the Army medical corps for an example of excellent quality, low cost, and low instances of litigation in government healthcare.
Its not about private vs public. Its about setting up a system with minimal stupidity. You have good ideas here, but your insistence on narrow definitions and polemics limits their appeal.
Yeah, I still disagree. It is a public/private issue. A government operated system can’t run effectively when it doesn’t operate under market-based pricing. The VHA is not nearly the success story as the Left makes it out to be. Veterans are placed in one of eight groups according to their degree of disability. Unsurprisingly, the most disabled group receives the most care, which, for the record, doesn’t mesh well with this death panel mentality that the sickest should be restricted care. What isn’t often revealed is that even the most disabled veterans only look to the VA for about 50 percent of their care. It’s far from comprehensive. Never mind their electronic health record systems have been a bit of a bust. http://reason.com/blog/2011/11/14/sorry-but-the-va-isnt-a-model-health-car http://healthblog.ncpa.org/the-hit-scam/
As for my narrow definitions, I’m not sure what you mean.
I recently interviewed the chief of staff of a hospital on this very issue. He is an old school conservative: Army Major, internal medicine doc, voted Republican every election of his life, etc. He pointed out many of the things you did in terms of medicare payment issues. He did say the Army medical corps was by far the best system he worked within.
He felt the right puts far too much faith in the private insurance market, whose goal is merely profit, not care.
As for definitions, like I said, I agree with much of what you are saying. However when you define the whole issue as “government = bad” and “private sector= good” it doesn’t leave much room for middle ground. Perhaps I should have used framing instead.
Also remember that much of health care does not act like a typical commodity. People don’t shop around for the cheapest hospital when they have a heart attack or are diagnosed with cancer. They are tying to stay alive.
In other parts of health care, like plastic surgery or lasik eye surgery, competition works very well. I don’t know how one crafts a system that encourages competition in some aspects of care but not others.
Its a good discussion to have, though.
The VHA may be the better than the other government-overrun healthcare options, but that’s not necessarily a rousing endorsement. That’s like finding someone satisfied with the USPS even though they have no other entity to compare it to.
To be honest, I don’t understand this idea of pitting “profits” against “people.” In a free market, profits can only be made by serving customers (i.e. people) better by providing better quality products and lowering prices through cost reductions. People so often chastise corporate profits without realizing that it’s profits earned by a successful and beloved company that allow an expansion of service, so that others may come to enjoy the product.
I have to respectfully disagree with you about people not shopping around for insurance. It’s not some exception to the rule. As you stated, plastic surgery and Lasik eye surgery are notable counterexamples and prices have fallen while quality has improved. However, there’s the rising prominence of concierge medicine and facilities that do offer market prices for a vast number of procedures, such as the Surgery Center of Oklahoma (http://reason.com/reasontv/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi). But, aside from that, there actually was a time when people did shop around for insurance policies. Back in the days of indemnity plans, policyholders received fixed insurance payments and if the policyholder could find services cheaper than the insurance payment, the person got to keep the difference! This spurred people to be cost-conscious when purchasing medical care. Nowadays, we have prepaid medical care, which means that policyholders never see a penny. A check is simply sent directly to a hospital or an imaging lab. So, yes, people don’t have an incentive to shop around…anymore. After all, it would only serve to save the insurance company money, not the policyholder.
And while private insurers might look like some market-based entity, it may come as a surprise to learn that roughly 85 percent of them simply use the Medicare fee schedule, which is based, not on market prices, but on some convoluted algorithm.
People shop for insurers, but not the healthcare services directly (except things like lasik that typically aren’t covered). The insurance market ought to be expanded, as Republicans advocate, to allow cross-state competition.
In an all private system, one has to be able to qualify for insurance, however. Pre existing conditions disqualify you for insurance without regulations. Lifetime caps also apply without regulation. There is no profit incentive to allow people with to wait until they are sick to buy insurance, or to pay for their care indefinitely. That’s the real death panel in this whole discussion: when private companies set caps and refuse to pay for care. Also, those without money die like dogs while those with money live. There is the moral aspect to consider in all of this.
The insurance companies’ incentive is to deny care. Every time they pay out, it cuts into their bottom line. Without regulations, insurance companies can simply collude together to offer all the same services, get bigger and bigger, swallow up the smaller insurance companies until there are only two or three large companies left.
Josh, I just got through telling you that people used to shop around for healthcare services in the days of indemnity plans. People received fixed sums and then went to see whomever they wanted and then the policyholder got to pocket the difference. Now, we don’t have that luxury thanks to third-party payers.
Pre-existing conditions would not be an issue in a free market. It would just require that people pay more into the pool. As for people being left to die like dogs, I feel like I’m repeating myself here because I already addressed those concerns in one of my earlier responses. I think that markets would be able to accomplish a lot more if left unencumbered (did you check out the Oklahoma Surgery Center?) and that neighbors, churches and charities would then feel more compelled to plug the gap given people’s greater vulnerability. Right now, we expect government to care for our neighbors, not us, which is troubling. We obviously won’t come to an agreement here, but I sincerely believe that the answer is not more government. As I said earlier, more government gets you results like a 9 month waits for neurosurgery and it flies blind without market pricing. It’s literally impossible for any government service to be run effectively and efficiently since central planning is anathema to market forces. Hence, the need for greater deregulation and privatization for better outcomes.
Anyway, I’m going to call it a night.
Blessings, Ian
Good chatting with you.