Giuliani's Tepid Health ReformThe health-care primary, Part 3.
Posted Thursday, Aug. 2, 2007, at 9:08 PM ET
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StumbleUponHow universal? Not very. See "Cost."
How socialistic? There is that pesky (and unspecified) Medicaid expansion. The plan includes tax credits and exclusions, but according to strict Republican anti-tax doctrine tax cuts can never be counted as government spending because that assumes the taxpayer's hard-earned dollar by rights belongs to the government. Back here in the real world, tax cuts do constitute government spending because they have to be offset with tax revenues if the government is to remain in operation.
How disciplined? Not much of an issue here, because apart from the vaguely described transparency requirements (see "Market Gimmicks"), I see any no new burdens that insurers (or even doctors) would feel motivated to evade.
Impact on employers: I will now say something nice about this plan. Giuliani (like Bush before him) takes a step toward leveling the playing field between people who pay for their own health insurance (mainly the self-employed) and people who receive health insurance through their employers. The latter benefit from a tax break unavailable to the former. That's unfair. Remedying this will accelerate employers' flight from providing health insurance to their employees, which would be a good thing. Giuliani doesn't quite have the guts to say that, and at one point he cites increased employer contributions as one of several revenue sources to increase coverage for low-income people. He doesn't explain how this would work. But to whatever extent Giuliani wants to relieve American employers from a burden of social welfare that ought to reside with the government, I'm for it.
Longevity: Not really an issue here. Private insurers would continue to cover most employees for a relatively short time, either because the employees change jobs or because their bosses switch to other, cheaper providers. Giuliani does, however call for greater investment in computerizing health records, which would at least give doctors a better shot at learning what previous doctors have done to their patients.
E-mail Timothy Noah at .
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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)