Proposed Direction

RE: rising costs of healthcare

Without allowing us to get too far afield here, I concede and/or agree to the following:

• We have dismantled the idea that medical malpractice reform would significantly reduce costs. It may help fix a system that needs fixing for other reasons of fairness, but it would do nothing for costs. The Republican-controlled Congressional Budget Office came to this conclusion as well, in comparing states with tort reform and states without it.


• You are correct: A government-run system would likely reduce costs in the short to medium range term, but it is harder to tell over the long-term. However, this would take an expensive period of setup and adjustment, which I'm sure you'd agree is the case.


• We are now arguing largely over whether the system can be fixed by government action or not. Clearly, we have agreed that healthcare is becoming unaffordable for many people who are working to support their families, and some options must be explored to help them with this goal (supporting healthy families).


• Doctors are better paid here than any other country, and under a government-run system that lowers or destroys profit-seeking motives, they would likely receive lower pay. This is actually why one of the largest all-time lobbying efforts occurred when President Truman attempted to create universal healthcare and the Amer. Medical Association stopped it cold dead.

But, let us not argue yet over the specific implementations of universal, government-run healthcare or even specific part-way government interventions (in the case of Kerry-Edwards, for example, neither of whom has proposed universal healthcare). Some of your nitpicking is over the particular ways that some countries have pursued their programs; we do not have to follow them, so this nitpicking does not address whether a program should be attempted in this country or not. Keep in mind that we may just do things better than Sweden, and solve a lot of their problems from the get-go just by using their experience as a guide, should we go down that road. This is America, after all!

There is a very relevant piece in The New Republic this week ostensibly defending Edwards against the smear of being a "trial lawyer" but the writer is actually strongly critical of "trial lawyers" themselves. It is worth looking at because although it does not go into the depth that I have, it also comes to the conclusion -- in agreement with the Republican Congressional Budget Office -- that "tort reform" as President Bush has advocated, would do virtually nothing to solve the problems of rising healthcare costs.

This is not actually a demerit for President Bush, and my point is not political -- actually, I am just making the conclusion that on this issue, the issue of "rising healthcare costs," Bush and the Republicans in D.C. have not articulated a strong position that has not been debunked by even their own CBO. This is important, because even if you do not agree with the Democrats' plan for healthcare reform, their ideas have not been debunked in this way, period.

This cedes the argument to the Democrats -- but not because they are correct. It cedes the argument because there is simply no Republican political argument, no programme, nothing. In effect, this means that if you want meaningful healthcare reform in terms of costs and access, then there are two paths -- Democratic politics and taking care of yourself and your family without the government. In as much as people believe they can handle the present system, they will vote with their feet when healthcare issues come to the fore. If they believe they cannot handle it in any way, shape, or form, they will vote for reform, and for Democrats. But this is assuming that they understand that the Republicans are not offering anything.

Which, for healthcare, they are not. I think we have proven that, relatively speaking, in our conversation. How? Because your arguments, while valid and interesting, have not issued forth from the Republican platform or the typical conservative line. The only things we have strongly debunked are, in effect, President Bush's proposals to curb the costs of rising medical care. Since he proposes nothing else to lower costs or improve access (no access is a very high cost indeed), there is nothing else to be said for him on this narrow issue.

Proposed: I think we have to take what we have learned and agreed upon and come to some preliminary conclusions. I am going to make reference to some Democratic proposals during the primaries as a way of differentiating between competing proposals. See what you agree with, from the following statements:

• Being that, all competing government proposals do not seem to address the spiraling costs of healthcare, the only proposals for action on the Government's part involve active involvement in the healthcare markets and industries, to a greater [Kucinich, Nader] or smaller extent [Kerry-Edwards, Lieberman].


• Given: That there are 10s of millions of uninsured children, families, and working citizens in this country, you must either conclude
  
  
  1. That they are already doing all that they can do to keep their budgets lean and provide healthcare for their families, whether their employer provides it or not.
  
  
  2. That they could do a significant amount of work themselves to reduce their healthcare costs and purchase healthcare insurance for their entire family, even within a failing system.
  
  
  
  If you conclude #1, the logical inference, I think, is that the proposals mentioned above are the only way to go. If you think the system is breaking or already broken, and you do not think that independent, decentralized action on the part of individual families will solve it (hands-off approach) then you must insist on government intervention.
  


• The debate is now whether or not individual families can do very much to change their behavior and choices to lower their healthcare costs or purchase healthcare when they do not have it (as 21-31 million citizens do not).


• I have plenty of arguments in favor of universal healthcare, and I have yet to find credible arguments against it that I take very seriously (for example, I do not believe that the best doctors are the highest paid ones). But that argument is without purpose until there is concurrence that universal healthcare is necessary.