Better Medicine
One area where John Kerry has indubitably offered pro-active solutions for real problems is in health care. Kerry has a bold and interesting plan whose central feature transfers the high costs of catastrophic health care from the private insurance system – which is increasingly unable to handle the rising costs of treatment without dramatically raising premiums – to state and federal government. This accomplishes two things. First, it socializes the costs across a broader revenue base, which will help ensure that those relatively few patients who require catastrophic medical coverage will actually receive it. And second, it removes a high cost from the insurance system, which means that insurance companies will have more resources to cover routine and less-costly procedures at lower cost to their customers.
If this works, it will have a profoundly beneficial effect on millions of Americans by making private medical insurance more affordable, and by relieving those unlucky families struck by medical catastrophe from an unreasonable burden of costs and uncertainty. This is a good idea in big throbbing capital letters. Nearly everyone who knows something about the issue thinks so, and the only reason to oppose it is if you are so blindly ideological that the idea of any state involvement whatsoever in the lives of American citizens is flat unacceptable.
Just for laughs, I went to George Bush’s website to see what the Prez proposes in terms of health care. His proposals include several flavors of tax credits (great if you happen to pay taxes – not so good if your medical bills are higher than your taxes), an initiative to increase investment in information technology for health care that I don’t think anyone opposes, and a measure to cap malpractice liability.
This last is pleasingly anti-lawyer and addresses the issue of spectacular jury awards to people with silly complaints like doctors who remove the wrong organ or kill a loved one by administering the wrong medication. But as it turns out, something like 98% of all malpractice is committed by 2% of doctors. If insurers were permitted to screen out the bad apples a little bit better, the real negative consequences of this problem – burdensome malpractice insurance premiums for honest docs – could be substantially if not completely mitigated. Republican supporters of “tort reform” know not to notice this fact, because it runs against their partisan goal of cutting off the political oxygen supply of a key Democratic fund-raising base.
As to medical savings accounts – tax-free ways for people to save money for medical expenses – this is a modest proposal to meet a highly immodest problem. It’s consistent with conservative philosophy in terms of using tax cuts rather than government support, encouraging thrift and individual responsibility and all that, but it just plain will not solve the problem for most people. Catastrophic health care costs run into the hundreds of thousands of dollars. No one has that kind of money sitting around, tax-free or no. And the tax savings for people in lower brackets don’t begin to compensate for the high and rising cost of premiums.
In point of fact, there is nothing that Bush proposes that would help even 5% of the number of people whose actual lives and finances would benefit from Kerry’s plan. There’s simply no comparison. And all the objections Bush can muster on his site against Kerry are ideological. Here’s what he says:
Kerry’s plan simply shifts the burden to the taxpayer. What Kerry claims is a “savings” of 10 percent is simply a shift of the burden of high health care costs to the American taxpayer. In addition, the Kerry reinsurance program is only available to employers and insurers who agree to mandates of the level of coverage, the use of savings, and the eligibility of workers.
Strictly speaking, this is true. Kerry’s plan moves the extremely high cost (but low incidence) of catastrophic health care out of a private system – which has to pass those costs on to a limited number of premium-paying customers – to a public system, which can distribute the costs over a much larger revenue base. Sorry, why is this a bad thing? Currently, employers and individuals who pay for private health insurance subsidize catastrophic care for a very small number of people by paying excessively high and rising premiums. “Shifting the burden” to the taxpayers – who are much better able to bear it than increasingly-strapped insurers and their customers – makes perfect sense to anyone who doesn’t mutter the sayings Ayn Rand in their sleep. We, the taxpayers, pay to rebuild people’s houses when natural disasters strike, at a cost that sometimes runs to the billions. Why is a medical emergency any different? Health care is a public concern, and it’s perfectly appropriate that we pay for the most extraordinary incidences of it with public money.
As to Bush’s second objection – the mandates and availability restrictions – again, this is perfectly responsible policy. Why would you enact a system like this without safeguards to guarantee compliance? Why would you not require participants to make proper use of the funds or make certain that private firms are living up to their obligations to employees and the public? This is a silly and frankly bizarre objection, meant to stir up the anti-gov’ment rubes in the GOP base rather than contribute anything meaningful to the policy debate.
You hear a lot lately that Kerry is “just about the negatives” or is running only on not being Bush. This is one area where he’s made a serious and substantive policy proposal that is relatively modest in scope, yet will address a problem that faces millions of Americans. Moreover, this catastrophic health care proposal is just one of several policies meant to address critical shortcomings in the system in a much more serious way than empty talk about medical savings accounts, tax breaks and tort reform.
Maybe health care is too wonky for the masses, and too complicated for the media, although I haven’t had any trouble summing it up in less than 2 pages. Still, based on what the two candidates have said on the issue, it’s reasonable to conclude that Kerry is actually interested in solving a problem that affects real people every day, and Bush is just covering his base.
7:59:10 AM 
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