Giuliani's Tepid Health ReformThe health-care primary, Part 3.

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)

• Cohen: How an Economic Crisis Is Like a War
• Froomkin: How's Bush? Put a Fork in Him.
• Milbank: A House Divided Along Twisted Lines
• Robinson: Ugly Politics at Justice | Q&A