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Monday, October 19, 2009

Ross Douthat Op-Ed at the Times

So, Mr. Douthat writes some interesting columns at the Times. As most in the paper's employ, his columns are fairly thoughtful--even for a conservative! This time though I'm mighty peeved.

Douthat suggests that we consider the plans of Martin Feldstein. I haven't read his plan, but Douthat's summary of it is atrocious.

The basic problem with healthcare now, beside the lack of insurance for 30-40 million Americans, and the terribly inadequate care for millions more, is that the costs are rising well beyond what anyone can reasonably be expected to pay. Douthat sums that up well. Where I think he errs, is that he advocates for universal catestrophic coverage. As anyone who has ever had catastrophic plans can attest to--this is an utterly implausible idea.

His words:

"Such a system would provide universal catastrophic health insurance, in other words, while creating a free market for non-catastrophic care. In the process, it would marry a central conservative insight that we'll never control spending so long as Americans are insulated from the true price of their medical care” to the admirable liberal premise that nobody should go bankrupt paying for life-saving treatment.

The details would vary depending on your political predilections. Under the more free-market approach, championed by Harvard's Martin Feldstein, the government would provide vouchers for the purchase of private catastrophic plans. Under a more liberal version, like the one sketched out by Berkeley's Brad DeLong, the government itself would act as the insurer. And liberals and conservatives would no doubt disagree about where to set the income threshold, and what additional interventions to support."

First of all, insurers always argue what merrits a catastrophy, and there's no reason to suggest the government would act differently. So that's debunked. Also, as several commentators point out--the main issues with rising healthcare cost is that current costs are based on a catastrophic coverage already. There isn't enough preventative care, which is cheap and effective, so that people are forced to wait until problems become catastrophic. My gf is a case in point. She was having terrible abdominable pains. For months she sat on them, and just lay beside me on the bed at night, moaning in pain. And she couldn't go to see a doctor, because that was two-three hundred dollars per visit that she didn't have. Finally she was admitted to the hospital, and the bill ended up going into several thousand dollars. Which her catastrophy insurance paid for--and the catastrophic treatment was largely ineffective anyway.

This phrase was particularly offensive to me, "it would marry a central conservative insight that we'll never control spending so long as Americans are insulated from the true price of their medical care." Fuck you Douthat. We are well aware. Every stinkin' one of us. Even the insured. But two or three hundred dollars to have a doctor prescribe advil until things get worse? Bullshit.

I had an ankle sprain earlier this year. My healthcare provider paid for three months of therapy. And they hate that. But if I hadn't had that therapy--I couldn't have gone back to work for months, and may well have had that injury permanently. But no catastrophic plan would ever have paid for that. And left to my own devices, I never could have either.

There is a moral imperative here. The welfare of the people is the government's only going concern. And it's in their best interest. The more we work, the more we earn, the more we pay. Is that free market enough for ya?

And vouchers? Seriously? The voucher system is lousy, ineffectual, and adds entirely too much beauracracy.

Costs are rising. Largely because the government is prevented by law from bargaining with providers, and drug companies. This needs to change. The government is the single largest purchaser of drugs and healthcare--if they're not in the market, then the market prices are inflated and controlled by an oligarchic industry.

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