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NRO’s domestic-policy blog, by Reihan Salam.


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Health Wonk Review Review: Those Confusing Conservatives

Not so long ago, most liberal bloggers and policy wonks debated health care policy amongst themselves, without much reference to the conservative point of view. Most frequently, as if to channel Lionel Trilling, they dismissed conservative arguments as irritable mental gestures.

The most recent edition of Health Wonk Review, hosted by Julie Ferguson of Workers’ Comp Insider, appears to reflect a shift on this score. Perhaps it is a reaction to the persistent unpopularity of PPACA, given that many liberals were once confident that the law would gain in appeal once it was passed. Whatever the reason, the port side of the health care blogoboat is spending more time engaging the starboard, often constructively and sometimes not. I hope the trend continues.

One such example is Michael Tanner’s new report entitled Bad Medicine: A Guide to the Real Costs and Consequences of the New Health Care Law. Tanner argues that the law leaves 21 million Americans uninsured, despite its promises of universal coverage; that it will add $352 billion to the national debt over its first 10 years of full implementation; that health costs will increase at an accelerated rate; that the law’s $669 billion in new taxes “will significantly reduce economic growth and employment”; that it allows the government to interfere with how doctors practice medicine; and will disrupt existing coverage for many Americans.

Maggie Mahar of the Century Foundation, in “Part 1” of what she promises to be an extended rebuttal of Tanner’s report, disputes the claim that PPACA is unpopular. “What bothers me is…the fact Tanner is using old numbers,” she writes. But the new numbers don’t aid her case either. Personally, I find this debate a bit of a sideshow: I would oppose PPACA even if it was popular, and I would expect Mahar to support it even if it was unpopular.

Joe Paduda of Managed Care Matters declares that he is “confused” about conservative criticisms of PPACA, and it appears that he is:

There’s a bit of hypocrisy, or perhaps more kindly, ignorance among those who criticized ‘Obamacare’ for its ‘socialist’ leanings and now fault reform for benefit plan changes implemented by employers seeking market answers to rising costs…Critics can’t have it both ways. Either decry the bill for its weak cost controls and governmental ‘takeover’ of health care, or slam it for forcing employers to change plans to control costs because the bill doesn’t do enough.

Conservatives aren’t criticizing insurers for attempting to control costs. Conservatives are criticizing PPACA for introducing a blizzard of mandates which make insurance more expensive, forcing those insurers to raise premiums or increase cost-sharing. Requiring every health plan to pay for acupuncture, for instance, is a surefire way to increase costs; if insurers are to keep premiums constant, they are forced to cut other benefits, or increase cost-sharing, in order to pay for that benefit.

Princeton economist Uwe Reinhardt, on the Health Affairs Blog, wonders why conservatives advocate more competition among insurers. “I find it hard to believe that…fragmenting the buy side of health care even more would serve the goal of cost containment.” The conservative argument is two-fold: as Reinhardt speculates earlier in the post, interstate competition allows consumers to buy insurance from less-costly states; in addition, allowing insurers to gain a larger scale will allow them to counteract the power of hospital monopolies.

David Williams of Health Business Blog criticizes Republicans for passing the Medicare prescription drug benefit, at a cost of $50 billion a year, without any fiscal offsets. He suggests cutting the subsidy in order to send more Medicaid money to the states.

Jared Rhoads of the Lucidicus Project, an Objectivist blog for medical students, takes Mitt Romney to task for advocating further government control of the health care system in his book, No Apology.

Jan Sidorov of the Disease Management Care Blog is worried that, as the Medicare “doc fix” problem remains unfixed, physicians will stop taking Medicare patients, hindering access to health care for the elderly.

Beth Capell of the Health Access Blog celebrates the new insurance mandates of PPACA, arguing that they will eliminate “junk” insurance and require that all plans cover basic health benefits including “mental health and substance abuse.” The problem is that the insurance model should take exactly the opposite approach, letting individuals pay for such routine care out-of-pocket, and instead cover catastrophic care. Capell’s approach is precisely why the cost of insurance keeps going up.

Finally, Louise Norris of Colorado Health Insurance Insider raises concerns about the increased frequency of Caesarean sections. She argues that obstetricians are financially rewarded for performing more C-sections, and that reforming payment for these procedures could help keep costs down.

New on The Agenda. . .


COMMENTS   5

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   07/23/10 16:08

We've heard all of these trite and tortured arguments before.

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 JEM
   07/23/10 16:34

A bunch of alleged experts who are expert on being experts and nothing else. The ignorance on display is breath-taking.

To Ms. Norris, it is all rather simple, ready? Trial lawyers.

This group of essentially evil people are eliminating the availability of doctors to deliver babies due to malpractice premium explosions. The stats are all over. So why C-Sections?

In a birth, the minute any distress is noted, there could be cause for just taking the baby C-section. The question is always where do you make the call - for C-sections have their own set of problems and rushing into emergency surgery is never optimal. If you don't do the C-section, and even though you did everything correctly, and the baby has a problem, the doc is dead in court if the plantiff's attorney can just say - you could have avoided this by doing the C-section. Juries have zero credibility in birth malpractice suits and judges themselves aren't much better. C-sections are defensive medicine on steroids.

Lawyers are driving women back to the conditions that used to make childbirth a potentially deadly endeavor. Thanks alot. Take all theses fools and tell them to get out of their stupid ivory towers and go talk to people who actually do the work in the real world.

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   07/24/10 12:08

Health insurance costs reflect medical costs. Insurers can do stupid things to increase costs, especially Medicare, but, for the most part, insurers are not the major influence. To me, the big factors (beyond inflation) are the trial lawyers and technology advances.

Medical technology advances have been breathtaking, but they are not free; they are very expensive. And, they snowball be keeping people alive who previously would have been dead. These people must be cared for, further increasing overall costs.

Trial lawyers make doctors try to protect themselves by running tests and performing procedures they don't need to do. Of course, insurance companies go along with this for the same reason.

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   07/25/10 11:21

The others who have posted responses to this article are all quite right in their observations, but at a higher level, I find Avik Roy's main point quite interesting - it is perhaps more significant than many might realize.

For the past several years, the overwhelming response by liberals, whether experts or merely advocates, to conservative proposals on almost every issue has been either to ignore or dismiss. This worked in the past because public sentiment was not sufficiently aroused against legislation and policy which were left-of-center. Now, however, as Roy notes, there has been enough resistance that real arguments are required by those on the left - the debate must be joined or they risk becoming minimalized.

Conservatives have been in this position for several years, constantly refining and honing their positions, whereas liberals have been content to offer the same arguments over and over. I expect the renewed debate to be analogous to a lumberjack contest between a well-conditioned contestant with a sharp axe on one side, versus one with the same relative skills who has been watching other lumberjacks on TV while his axe has begun to rust from neglect - should make for good entertainment for the wonkiest among us.

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   07/26/10 09:43

Hi Jay,

Lawyers and new technology do play a role in rising health care costs, but just pause and think about it -- why is it that, in every other sector but health care, technology *decreases* costs?

The reason why technology drives up health care costs is because new technology is not priced by the market, but rather by governments and government-distorted insurers.

If people paid for routine health costs out-of-pocket, there simply would be no market for technologies that didn't make people healthier at a reasonable price. The fact that government, in particular Medicare, massively subsidizes overutilization (and thus overpayment) for marginally beneficial medical technology is the fons et origo of health care inflation.

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