Prager: 10 Questions on 'ObamaCare'

Here are some pretty good answers, I reckon:

#1 The Blue-Dog Democrats have already proposed a way to tackle rising and unequal Medicare and Medicaid costs with the help of industry experts:

http://economix.blogs.nytimes.com/tag/uwe-e-reinhardt/

Anyway, I won't stand for Prager's cute demand that we solve the problems with supplemental health provision for the aged (Medicare) before we figure out how to provide affordable access for everybody else.

#2 assumes that people will go out of their way to avoid buying affordable medical insurance. The experience of other countries does not support this assumption. In fact, the real potential drawback of mandatory health insurance is that people will overuse it. However, compared to our current insurance system, which keeps a wide open gate to all kinds of specialists and expensive tests, with only a small co-pay, I would say we are already overusing medical care.

#3 I suppose he's referring (blithely) to emergency rooms. This is no way to run a health care system or control costs. ERs are extremely expensive. Regular, preventive medicine is cheaper and ensures better health outcomes.

#4 Does Prager think there is moral justification for having private insurance companies ration care? Because they do already, right now. Insurers have entire departments specialized in "recission," which is a euphemism for finding pretexts to deny insured patients the care they are entitled to, in order to cut the insurer's costs.

http://articles.latimes.com/2009/jun/17/business/fi-rescind17

I'm glad Prager mentioned morality. We sometimes forget that health care is not and cannot be a "business" in the normal economic sense, because it has an inherent moral and ethical imperative: medical professionals take an oath acknowledging their ethical obligation to treat the sick. The tricky part is how to reconcile their ethical obligation with market forces and the profit motive. How moral is it for us, as a nation, to tolerate vastly inequitable standards of care and health outcomes for the country's have's and have not's? Health care is literally a life and death matter. It is not straight economics.

#5 It's not accurate to say that drug development is an American enterprise. I work in the industry for a U.S. company in E. Europe. Clinical trials happen all over the world, with increasing frequency in E. Europe, Latin America, and India. Outsourcing of drug development is the future, just as outsourcing in so many other industries is occurring. It would be more accurate to say that Big Pharma's most lucrative market is the United States, for the reason that Americans are willing (but decreasingly less able) to pay for expensive drugs. In essence, U.S. patients, by overpaying for the blockbuster drugs while they're "hot," subsidize drug development for the entire world. But I'm not sure we should call that a "plus" of the current system.

There is a lot of waste in Big Pharma and the drug development process could be streamlined. The hugeprofits in the U.S. of the blockbuster drugs cover up a lot of inefficiency in the pharma industry.

#6 I frankly don't care if private health insurance companies survive, but... They could make money by providing supplemental insurance, or insurance for care not covered by gov't health insurance -- like expensive diagnostic tests, cosmetic surgery, home nursing care, whatever.

#7 is a false assumption. Look now at how doctors and hospitals offer deep discounts for payment in cash at the time of treatment. This is because private insurers can take up to 120 days to pay. Meanwhile, the doctor has loads of paperwork and a big back office to do it all. With one single (or major) payer, doctors and hospitals will get paid faster. Anyway, the incomes of doctors in Canada and W. Europe are as big or bigger than U.S. doctors. Interestingly, in the U.S. there are now discount agencies -- not insurance companies -- which encourage you to join for a monthly fee, and then negotiate discounts for you with doctors and hospitals. The catch is that you still have to pay in cash at the time of service. And probably you could negotiate the same discounts for yourself, if you cared to haggle and promise payment in cash. But you see a whole business has sprung up because of the slowness of insurance payments. Time is money and cash is king.

#8 Is another false assumption not supported by the facts. As the Dallas Morning News reported back in April, Texas amended its constitution in 2003 to cap medical malpractice payouts, and yet health costs in Texas have continued to rise. The article also points out that a study on damages caps and overall health costs in 27 states and found no significant effect on costs or so-called "defensive" medicine:

http://www.dallasnews.com/sharedcontent/dws/bus/columnists/jlanders/stories/DN-Landers_21bus.State.Edition1.9be351.html

As the article asks, we ought to be very sure about the cost-benefit trade-off before we limit our right to seek legal redress of grievances. Indeed, Milton Friedman of all people said that gov't safety and consumer protection regulation was not necessary because people could always sue for justice in the courts. There is no gov't regulator of medical malpractice in the U.S.

#9 Let's see the entire, final bill before we critique the costs. Anyway, that $1 trillion for the Senate proposal would be spread over 10 years, or $100 billion per year. By comparison, we have spent over $500 billion in Iraq & Afghanistan over 6 years, and will have to pay up to $3 trillion all told. Roughly speaking, we can trade an Iraq war for health coverage for nearly every American. Even if that is the cost, we should consider it. What I have not seen an analysis of, is how much substitution spending would this bill take off of consumers' backs? Anyway, to get a grip on runaway costs, I encourage you to look at this economic comparison, showing that America already does suffer "excess spending" on private health care, and that that "excess" is not because of our ageing population, or better health outcomes:

http://economix.blogs.nytimes.com/2008/11/14/why-does-us-health-care-cost-so-much-part-i/

#10 No, Obama is right, we spend way more (see the link above) but that our higher spending is not linked to better quality or outcomes. The WHO rates France as having the best health care in the world. Cuba has the world's best survival rate for breast cancer, and it is an impoverished Third-World victim of embargo. Health care stats are all over the place. We should be wary of quoting them selectively.

10 Questions for Supporters of 'ObamaCare'

By Dennis Prager

July 28, 2009 | Townhall.com

1. President Barack Obama repeatedly tells us that one reason national health care is needed is that we can no longer afford to pay for Medicare and Medicaid. But if Medicare and Medicaid are fiscally insolvent and gradually bankrupting our society, why is a government takeover of medical care for the rest of society a good idea? What large-scale government program has not eventually spiraled out of control, let alone stayed within its projected budget? Why should anyone believe that nationalizing health care would create the first major government program to "pay for itself," let alone get smaller rather than larger over time? Why not simply see how the Democrats can reform Medicare and Medicaid before nationalizing much of the rest of health care?

2. President Obama reiterated this past week that "no insurance company will be allowed to deny you coverage because of a pre-existing medical condition." This is an oft-repeated goal of the president's and the Democrats' health care plan. But if any individual can buy health insurance at any time, why would anyone buy health insurance while healthy? Why would I not simply wait until I got sick or injured to buy the insurance? If auto insurance were purchasable once one got into an accident, why would anyone purchase auto insurance before an accident? Will the Democrats next demand that life insurance companies sell life insurance to the terminally ill? The whole point of insurance is that the healthy buy it and thereby provide the funds to pay for the sick. Demanding that insurance companies provide insurance to everyone at any time spells the end of the concept of insurance. And if the answer is that the government will now make it illegal not to buy insurance, how will that be enforced? How will the government check on 300 million people?

3. Why do supporters of nationalized medicine so often substitute the word "care" for the word "insurance?" it is patently untrue that millions of Americans do not receive health care. Millions of Americans do not have health insurance but virtually every American (and non-American on American soil) receives health care.

4. No one denies that in order to come close to staying within its budget health care will be rationed. But what is the moral justification of having the state decide what medical care to ration?

5. According to Dr. David Gratzer, health care specialist at the Manhattan Institute, "While 20 years ago pharmaceuticals were largely developed in Europe, European price controls made drug development an American enterprise. Fifteen of the 20 top-selling drugs worldwide this year were birthed in the United States." Given how many lives -- in America and throughout the world – American pharmaceutical companies save, and given how expensive it is to develop any new drug, will the price controls on drugs envisaged in the Democrats' bill improve or impair Americans' health?

6. Do you really believe that private insurance could survive a "public option"? Or is this really a cover for the ideal of single-payer medical care? How could a private insurance company survive a "public option" given that private companies have to show a profit and government agencies do not have to – and given that a private enterprise must raise its own money to be solvent and a government option has access to others' money -- i.e., taxes?

7. Why will hospitals, doctors, and pharmaceutical companies do nearly as superb a job as they now do if their reimbursement from the government will be severely cut? Haven't the laws of human behavior and common sense been repealed here in arguing that while doctors, hospitals and drug companies will make significantly less money they will continue to provide the same level of uniquely excellent care?

8. Given how many needless procedures are ordered to avoid medical lawsuits and how much money doctors spend on medical malpractice insurance, shouldn't any meaningful "reform" of health care provide some remedy for frivolous malpractice lawsuits?

9. Given how weak the U.S. economy is, given how weak the U.S. dollar is, and given how much in debt the U.S. is in, why would anyone seek to have the U.S. spend another trillion dollars? Even if all the other questions here had legitimate answers, wouldn't the state of the U.S. economy alone argue against national health care at this time?

10. Contrary to the assertion of President Obama -- "we spend much more on health care than any other nation but aren't any healthier for it" -- we are healthier. We wait far less time for procedures and surgeries. Our life expectancy with virtually any major disease is longer. And if you do not count deaths from violent crime and automobile accidents, we also have the longest life expectancy. Do you think a government takeover of American medicine will enable this medical excellence to continue?