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Giuliani's Tepid Health ReformThe health-care primary, Part 3.
By Timothy NoahPosted Thursday, Aug. 2, 2007, at 9:08 PM ET"We've got to do it the American way," Republican presidential candidate Rudy Giuliani said as he unveiled his proposal for health-care reform.
The American way is not single-payer, government-controlled anything. That's a European way of doing something. That's a, frankly, a socialist way of doing it. That's why when you hear Democrats in particular talk about single-payer, mandated health care, universal health care, what they're talking about is socialized medicine. They're talking about single-payer—government—controlling your health-care decisions.
Oh, please. The American way is to pretend we don't already have socialized medicine for the elderly (through Medicare) and for the poor (through Medicaid). The only controversy surrounding these programs is the term "socialized medicine" itself. Certainly one hears few complaints, even from blowhards like Giuliani, that Medicare and Medicaid are too socialistic (though the Bush administration and Congress have done their best to screw up the former by mandating a role for private health insurers, who do the work less efficiently).
President Bush is threatening to veto legislation passed this week that would extend health insurance for the working poor to an additional 3 million (the Senate version) to 5 million (House version) additional children. "When you expand eligibility ... you're really beginning to open up an avenue for people to switch from private insurance to the government," Bush told the Washington Post last month. Let's have a show of hands. Readers, how many of you get your health insurance from the sainted private sector? If offered the chance tomorrow to chuck that private plan and go on Medicare, how many would refuse? Anyone? Surely there must be one … no?
"Got to have private ownership," says Giuliani. Let's see how his plan measures up.
Candidate: Rudy Giuliani.
Elegance: Very inelegant. A few tax breaks here, a few block grants there, a sprinkling of tort reform; he even, if I'm reading this right, would increase modestly the quantity of un-American socialized medicine available through Medicaid. Rudy, you devil!
Market gimmicks: Plentiful. Rudy's plan promises "visibility of price, provider qualifications, and risk-adjusted procedure outcomes," all wonkspeak for less games-playing by doctors and insurers about what they charge, what they'll pay, and the likelihood that any given procedure will yield results. Unfortunately, obscuring these matters is one thing that private-sector medicine has proved exceptionally skillful at. Giuliani also proposes the creation of "interstate markets," though there's no explanation of how these would work. He would also expand health savings accounts, which are merely a ruse to make the insured think that when they see their insurance benefits reduced the fault lies with their own bad consumer choices. In truth, if one is to insure oneself and one's family responsibly against medical misfortune, there are very few "choices" to make.
Susceptibility to the insurance lobby: Hard to say, because Giuliani doesn't really specify how he'd regulate insurers. There is, in fact, nothing in Giuliani's plan that would offend any insurance company, and that may be the point.
Cost: Impossible to quantify, and Rudy doesn't even try. Media Matters For America thinks Giuliani is getting a free ride on the cost question. Probably, though, it would cost less than the Democratic plans, if only because it doesn't accomplish very much.
E-mail Timothy Noah at .
Timothy Noah is a senior writer at Slate. Remarks from the Fray:
Something else is and always will be misunderstood in the health-care debate unless something fundamental changes in our political culture. The Republicans have successfully turned "socialized medicine" into a sufficiently big, scary word that everyone else has lost the ability to point out the smaller but significant details necessary to understand the situation.
To wit: the advent of a single-payer system is typically portrayed with doomsday scenarios of Americans unable to choose their doctors, unable to obtain necessary procedures and squeezed like helpless, cute, furry animals in the coils of the big, bad government-incompetence python. Giuliani may or may not even recognize the assumption involved here - he might just be using what has become a familiar term of caricature because he knows how reliably it triggers an autonomic-nervous-system response from certain corners.
The fact is, a government-run health care system that guarantees a certain minimum level of health care for all citizens does not preclude the operation of private doctors and insurance companies who would cater to those who are able to pay for their own service. This second track of care exists in Britain already (I'm not sure about Canada), and most don't see the need to use it. For those who do, I'm sure that they are grateful that it exists. But the point is that its existence does not in any way preclude the provision for everyone else. If you want your cosmetic procedure, or if your cancer has exhausted all proven therapies and you want to try an experimental treatment, you can still do it - you just have to pay for it yourself. Which, incidentally, is exactly the way it works here already, since most private insurance companies tend to reimburse patients little, if at all, for this kind of thing (and rightly so).
As a doctor, I can't really say that I am excited about the federal government having a bigger role in health care; every time it gets involved in some new initiative to improve safety, transparency, privacy, or some other objective, it manages to miss its mark while creating more paperwork for doctors, nurses, and other caregivers (thus reducing the time they could be spending with their patients). But it's an unfortunate fact that it is coming eventually, one way or another. I tend to favor letting free markets work in most cases, but health care does not and will never constitute an effective free market. Costs will continue to increase faster than our collective ability to pay them, and eventually we will reach a tipping point at which the larger economy can no longer sustain the percentage of dollars going to health care. As far as I can tell, it's not a question of if, but of when and how it will happen. We can do it in the near future, at a time and in a way of our own choosing, so as to mitigate the shock and adjustment; or, we can wait for the moment of crash and settle for what will inevitably be a half-assed, second-rate patch-up of what has become an irretrievably broken system.
--Sawbones
(To reply, click here.)
Tim, count me as one of the ones who would not, under any circumstances, trade in my good insurance for a Medicare policy. You've GOT to be joking, you seriously think most people would happily trade in their coverage for that crappy Medicare if they had a CHOICE? You are seriously demented. I have two siblings who are dependant on medicare/medicaid, and I know what a lousy job that does of covering their basic needs - like limited perscriptions. Hey, if you need more than 2 perscriptions for chronic conditions, you are SOL on the medicare/medicaid plan.
Now, let ME ask a question: If Ted Kennedy gets his way and extends medicare coverage to EVERYONE in America, how many businesses would drop health care coverage all together? Yeah, I see alot of hands go up. Now, under this scenario, how many insurance companies would still offer health care policies, and how much would THOSE policies cost? I'm thinking very few companies would want to compete against something free, and the ones that continue to would "cater to the rich," so us middle-class employees would once again get the shaft from those wonderful liberals that are "so concerned about my welfare." So please, Ted and Tim, don't do me any favors.
--Ripley
(To reply, click here.)
(8/3)
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Remarks from the Fray:
Something else is and always will be misunderstood in the health-care debate unless something fundamental changes in our political culture. The Republicans have successfully turned "socialized medicine" into a sufficiently big, scary word that everyone else has lost the ability to point out the smaller but significant details necessary to understand the situation.
To wit: the advent of a single-payer system is typically portrayed with doomsday scenarios of Americans unable to choose their doctors, unable to obtain necessary procedures and squeezed like helpless, cute, furry animals in the coils of the big, bad government-incompetence python. Giuliani may or may not even recognize the assumption involved here - he might just be using what has become a familiar term of caricature because he knows how reliably it triggers an autonomic-nervous-system response from certain corners.
The fact is, a government-run health care system that guarantees a certain minimum level of health care for all citizens does not preclude the operation of private doctors and insurance companies who would cater to those who are able to pay for their own service. This second track of care exists in Britain already (I'm not sure about Canada), and most don't see the need to use it. For those who do, I'm sure that they are grateful that it exists. But the point is that its existence does not in any way preclude the provision for everyone else. If you want your cosmetic procedure, or if your cancer has exhausted all proven therapies and you want to try an experimental treatment, you can still do it - you just have to pay for it yourself. Which, incidentally, is exactly the way it works here already, since most private insurance companies tend to reimburse patients little, if at all, for this kind of thing (and rightly so).
As a doctor, I can't really say that I am excited about the federal government having a bigger role in health care; every time it gets involved in some new initiative to improve safety, transparency, privacy, or some other objective, it manages to miss its mark while creating more paperwork for doctors, nurses, and other caregivers (thus reducing the time they could be spending with their patients). But it's an unfortunate fact that it is coming eventually, one way or another. I tend to favor letting free markets work in most cases, but health care does not and will never constitute an effective free market. Costs will continue to increase faster than our collective ability to pay them, and eventually we will reach a tipping point at which the larger economy can no longer sustain the percentage of dollars going to health care. As far as I can tell, it's not a question of if, but of when and how it will happen. We can do it in the near future, at a time and in a way of our own choosing, so as to mitigate the shock and adjustment; or, we can wait for the moment of crash and settle for what will inevitably be a half-assed, second-rate patch-up of what has become an irretrievably broken system.
--Sawbones
(To reply, click here.)
Tim, count me as one of the ones who would not, under any circumstances, trade in my good insurance for a Medicare policy. You've GOT to be joking, you seriously think most people would happily trade in their coverage for that crappy Medicare if they had a CHOICE? You are seriously demented. I have two siblings who are dependant on medicare/medicaid, and I know what a lousy job that does of covering their basic needs - like limited perscriptions. Hey, if you need more than 2 perscriptions for chronic conditions, you are SOL on the medicare/medicaid plan.
Now, let ME ask a question: If Ted Kennedy gets his way and extends medicare coverage to EVERYONE in America, how many businesses would drop health care coverage all together? Yeah, I see alot of hands go up. Now, under this scenario, how many insurance companies would still offer health care policies, and how much would THOSE policies cost? I'm thinking very few companies would want to compete against something free, and the ones that continue to would "cater to the rich," so us middle-class employees would once again get the shaft from those wonderful liberals that are "so concerned about my welfare." So please, Ted and Tim, don't do me any favors.
--Ripley
(To reply, click here.)
(8/3)