Skip to comments.A Conservative Case for Universal Health Coverage
Posted on 12/13/2007 7:05:22 AM PST by cinives
I am a small-government conservative/libertarian and have hated the concept of socialized medicine almost all my life. But now, I could live with universal health coverage in the U.S.. Here's why.
We now have the worst of both worlds: we are paying for universal health coverage, but not getting it. In fact, we pay more for health care in taxes than countries that provide universal coverage. Then we pay more than that amount again in private coverage. Additionally, what we have now in the U.S. is nowhere near a free market in health care. Defending the status quo is not defending a free market. And if socialized medicine is your fear, we already have it.
I've heard no one, on either side of the political spectrum, play up the fact that the government in the U.S. already spends more on health care than almost every other country on earth. I'm talking government spending, not private spending. According to the U.S. Statistical Abstract, government spending on health care in the U.S was $2,168 per person in 2001 (the last year for which comparison data are available). Here were the top 10 government spenders on health care in 2001.
Norway: $2,550 U.S.: $2,168 Denmark: $2,098 Iceland: $2,025 Sweden: $1,832 Germany: $1,803 France: $1,599 Canada: $1,531 UK: $1,518 Belgium: $1,417.
If we add in private spending as well, it's not even close.
U.S.: $4,887 Switzerland: $3,690 Norway: $2,982 Denmark: $2,545 Iceland: $2,441 Germany: $2,407 Canada: $2,161 Sweden: $2,149 Netherlands: $2,134 France: $2,104.
Note that the countries frequently cited as models of universal health care, Canada and the U.K., spent less on public health than the U.S. did. Sweden, the notorious welfare state, spent 15% less than the U.S.. The only country to spend more, Norway, has about the size and population of Colorado, with oil exports over 3 million barrels per day.
Even as a fraction of GDP, government in the U.S. spent a comparable amount to other nations (6.6% in 2002). Canada spent just slightly more (6.7%), and Japan and the U.K. spent less (6.4%). Only seven countries of the 28 countries listed spent a greater fraction of GDP on public health funding than the U.S..
What about the private side, the "free market" side? There, government regulates the health industry and mandates what health insurance must cover.
While the U.S. does not have universal health coverage, it has had universal health care since 1986. Any person who goes to an emergency room in virtually any hospital in the country must be examined and then either treated or transferred to another hospital for treatment if the condition requires immediate care.
According to the Council for Affordable Health Insurance (CAHI), "By the late 1960s, state legislatures had passed only a handful of mandated benefits; today, CAHI has identified more than 1,900 mandated benefits and providers. And more are on their way." According to CAHI, such mandates include:
Providers such as chiropractors and podiatrists, but also social workers and massage therapists; Benefits such as mammograms, well-child care and even drug and alcohol abuse treatment, but also acupuncture and hair prostheses (wigs); and, Populations such as adopted and non-custodial children.
Then there are federal mandates such as minimum hospital stays for baby deliveries, equal coverage caps for both mental and physical health benefits and reconstructive surgery after mastectomies.
According to the CATO Institute, the net cost of health regulation in the U.S. is over $169 billion, or an average of $1,500 per household.
So let's review. The government provides Medicare for the old, Medicaid for the poor, veterans' hospitals for veterans, medical research funding and whatever else adds up to 6.6% of GDP. The federal government forces hospitals to provide emergency treatment to all comers. State governments mandate over 1,900 types of coverage on health insurance. Health care regulations cost the average household over $1,500.
We already have socialized medicine and we are already paying for it -- twice: once in taxes and once privately. What we are not getting is universal coverage.
But if universal care (via emergency rooms) is already mandated, what's the problem? First, it is not the best way to get treatment. For one thing, the condition has to be regarded as a medical emergency. Also, the law does not relieve you of having to pay for that treatment. In fact, medical bills are the leading cause of bankruptcies in the U.S., accounting for half of them.
So while you might not die, the U.S. health care system does give you the age-old offer of "your money or your life".
As small-government conservatives or libertarians, we could say, "That is the individual's choice: get the insurance or suffer the consequences." But if that is our policy, then why is our government paying over $2,100 per person per year and regulating health care at a cost of $1,500 per household? What are we getting for that money?
If we are to be consistent libertarians, then the government should stop meddling in health care and health insurance altogether. End Medicare. End Medicaid. Close down veterans' hospitals. Stop funding medical research. Stop funding pharmaceutical research. Stop mandating vaccines. Stop mandating emergency room treatment. Stop mandating health insurance policies. Stop doing those things that cost us 6.6% of our GDP when we have to kick in another 7% or more of our own.
If our government stopped all those things, then I would a happy libertarian. But the government will not stop them. If politics is the art of the possible, it is not possible to end all the programs and policies cited above. So ... if we are going to be forced to pay for something, then we ought to get it. Either provide us the coverage, or give us our money back.
Full disclosure: My daughter needed a heart transplant at age 15. We had full coverage from my employer, so cost was never a personal issue to us. I'm not sure what these things cost (neither did her cardiologist), but I believe the surgery and resulting hospital stay would be a few hundred thousand dollars. Testing and diagnostics beforehand could exceed $100,000. Anti-rejection drugs and follow-up testing could run to six figures yet again. I believe a total cost of $500,000 is not out of the question, with annual post-surgery costs in the five figures.
This was not a matter of elective treatment. There was nothing that could have prevented it. In my daughter's case it was a rare condition, with cause unknown, unforeseen and unforeseeable. The choice was do or die. And there was no decision on our part that could have reduced the cost in any significant way. There are no low-cost heart transplants. There or no alternative treatments. A bake-sale here or poker-run there would not come near the required amount.
If you are struck with such a catastrophic health crisis, you simply must have a very good health insurance policy or a net worth into the millions to avoid both death and bankruptcy.
And health insurance is not a trivial cost. Family coverage goes for about $13,000 per year or more. The median family income in 2001 was $51,407. The choice for some families is to pay over a fourth of their after-tax income on health insurance, or risk relying on emergency room care only and then going bankrupt should a catastrophic health issue come up. Many chose no or inadequate coverage, and many went bankrupt.
The cost problem is not one just for poorer families. At $13,000 and up per year per family, and growing faster than inflation, health insurance affects everyone. We now spend 15% of our GDP on health. Any Chief Executive Officer would love to have health insurance taken off his worry list. Any state governor would love to have Medicare removed from his federal mandates. It is impacting our productivity and competitiveness.
Let me make something else clear: universal health care coverage is not the same as single-payer health care. Canada and the U.K. have nothing to brag about regarding either the quality of health care or the cost of it. But those are not the only models of universal coverage. Germany, Japan and others have universal, or near-universal, health coverage without a single-payer system.
It would be naïve of me to propose a specific plan. But a true conservative ought to be able to work within the following guidelines.
Public health spending in the U.S. not to exceed current costs as a fraction of GDP (currently 6.6% of GDP). Coverage of all U.S. citizens. The definition of "coverage" could be debated, but should include catastrophic type coverage as a minimum. Consolidation and integration of all aspects of public health programs should be on the table, including Medicare, Medicaid, veterans' hospitals, research and all federal health programs and policies. That is, Medicare reform should be part of the deal. Preservation of private choices in health care. Medical tort reform. Reduced mandates on individuals, insurers, health providers and states regarding health care policies and practices.
I don't see why a small-government conservative or libertarian would think the above is worse than what we have now. I also don't see why the above should be impossible, even politically.
Someday, some sort of universal coverage is going to happen in the U.S. What plan would you prefer -- one consistent with the above, or one dictated by Hillary Clinton, Barack Obama or John Edwards? When Iraq becomes yesterday's news, Republicans need to be ready with this issue.
This is an issue that will become more important every year as costs rise.
Since we know that "free" care at emergency rooms is not going away, and nor is Medicaid/Medicare or VA hospitals, solutions should reflect these realities and striv to be as "efficient" as possible, preferably with little to no government bureaucracy.
How about not posting this repeatedly?
A Conservative Case for
Universal Health CoverageSocialism.
Take note - “For discussion - please read carefully before trotting out the reflexive posts.”
PING for later read.
The author offers no solution, just a recitation of costs. He doesn’t appear to understand what universal health care means. The devil is in the details.
The turn toward socialized and very expensive health insurance came with health maintenance organizations and tying health insurance to employment.
There is way too much government intervention in medical care, although I have no problem with the Feds caring for our veterans, who laid their lives on the line for our country's defense. However, migrating to socialized health care will inevitably result in the sort of shortages and rationing that have occurred in every other nation that has gone this route. The wealthy may be able to pay for surgeries and other medical care privately, if any socialized system provides for an opt-out as Britain currently does. Alternatively, they may be able to go to places like Singapore, Hong Kong, or some Caribbean island to get the services in a freer market environment. The middle class will be screwed under universal health care, as are their counterparts in Canada and Western Europe.
When you consider how poorly governments handle the services to which they have been entrusted, like highways, public schools, and the courts, there is no reason to believe that socialized medicine would fare any differently. The bottom line is that socialism never works.
I did a search of this, and no one else posted this. What’s your beef ?
Maybe we should quit discussing everything, since surely everything has come up at least once in the history of Free Republic ?
The author’s point is, we already have socialism in the health coverage “market”.
Mine is, we need to look at the programs already existing, and push a “solution” to at least get something better than we have now.
Medicare/Medicaid is going bankrupt, ie will be paying out more than it takes in in taxes in the next few years, so this is an issue that must be addressed very soon.
There is no Conservative case for UHC. Yes, I read the whole thing.
This statement is the springboard for the rest that follows. Problem, no one is defending the status quo. Some (Romney, Clinton, Edwards) argue for more govt control and others (Thompson, Giuliani) argue for less to no govt. control. This piece is a false argument based upon a phony premise.
Well, yes, but the details are something we as conservatives should start thinking thru so we can ask Congress/President to shape a conservative solution.
Yes, I know conservatives prefer no government in this area - I’m in the forefront of that idea. But, since Medicaid/Medicare, VA hospitals, S-CHIP and the like are not going away soon, how can we get to a better place thn we are now.
Even as this article indicates, the real problem is that health care has no known cost.
None of us really know what our health care costs. The market has been so thoroughly tampered that the costs are spread about by Leviathan forces.
If we had to pay our medical costs out of a pocket, we would witness market forces changing medicine for the better.
That is clearly the case but the rhetoric of health care is so vicious that it is hard to imagine a candidate prevailing on a return to the market.
I notice no one is saying much about Bush’s second veto of child health care.
Bush is lampooned as a conservative fraud and yet who can imagine any Republican candidate really resisting the political pressure to sign such a bill. . . FOR THE CHILDREN.
Bush has done pretty well to veto it twice without any positive response from his so called base.
I’d put the turn down to VA hospitals and Medicare/Medicaid plus mandates by states, and polished off in 1986 by “free” care in ER rooms.
Hundreds of hospitals across America have closed because they can no longer profitably operate because the federal law requires them to give free emergency room medical care to everyone who either has no insurance or cannot or will not pay for it.
Instead of throwing up our hands and surrendering to the Liberals in America; we should be deporting every illegal in America which would automatically allow hospitals, that are presently on the verge of closing because of the free hospital care that they are required by law to give to everyone including illegals, to remain open and DEMAND that only those who are in life & death circumstances be given free emergency room hospital care. An affordable national health insurance plan similar to what members of congress have could be instituted whereby everyone could be covered who isn't already covered by Medicare or Medicaid.
Don’t throw the baby out with the bath water;
throw the illegals out with the bath water.
"Liberalism is just Communism sold by the drink." P.J.O'Rourke
I saw nothing "Conservative" in the article.
“we are paying for universal health coverage, but not getting it.”
Since we haven’t received the bill for universal health care yet, I don’t know how anyone can say that. My suspicion is that the cost of health care will double if the government mandates universal health care. Currently, we’re told that 1/3 of the people aren’t getting the health care they should have, and that means we’re only providing 2/3 the amount of health care we should be providing, so that means we’ve got to provide 50% more health care than we are currently providing in order to cover that 1/3 who aren’t getting it.
Doctors already average 60 hour work weeks. In order to provide 50% more health care, the doctors will need to work 50% longer hours, which means 90 hours a week. There is no way you’re going to be able to get them to work 90 hour weeks without paying them a whole lot more than we are currently paying, and that means bidding up the cost of health care.
I’d rather the Feds help soldiers in a manner similar to the GI Bill after WW II - give insurance to the soldiers to buy whatever type of health care or insurance they want.
VA hospitals should not duplicate the private sector. I think we’d save a huge chunk of change and soldiers would get better care if we do the above.
I agree with you completely about socialism and bureaucracy never working.
For my part, I’d prefer tax credits for health insurance, HSAs, and no free care in the ERs.
Now how in the world can you group VA hospitals in with those other programs? VA hospitals are NOT entitlements. The folks there earned whatever care they get.
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