Saturday, June 9, 2012

Rick Perry's Fed Up 4: Health Care

For my write-up today on Rick Perry's Fed Up! Our Fight to Save America from Washington, I'll focus on health care.

Not surprisingly, Perry criticizes Obama-care because he believes that it creates costly government bureaucracies that interfere with decisions that patients make with their doctors, sets up death-panels that ration health care in an attempt to reduce costs, imposes regulations on businesses in a time when businesses need to create jobs, and establishes a health insurance mandate that violates the U.S. Constitution.

I am familiar with certain elements of Obama-care: the requirement that everyone have health-insurance, the expansion of Medicaid, and the requirement that health insurance companies not turn away people with pre-existing conditions.  But I do not know entirely what role the Patient-Centered Outcomes Research Institute and the Independent Payment Advisory Board----the so-called "death panels"----play in Obama-care.  From what Perry is saying, these boards concern what Medicare and Medicaid will reimburse, as Medicare and Medicaid base their reimbursements on what is considered to be cost-effective.  But can the federal government under Obama-care tell private insurance companies to follow its standards as to what is cost-effective?  I do not know.  The idea may be that encouraging Medicare and Medicaid to prefer certain medical procedures (i.e., preventative care) over others will lead the private insurance companies to do the same, since Medicare and Medicaid loom large in America's health care system.  Newt Gingrich himself says that Medicare should lead, and the private health insurance companies will follow.

Perry argues that the proposed Medicare cuts under Obama-care will lead 15 per cent of hospitals to close.  So Perry is against the federal government cutting the amount of money it spends, in this case?  How's that jive with his opposition to big government?

While Perry believes that the federal government has no constitutional authority to impose a health insurance mandate on Americans, he doesn't think that the health insurance mandate is a good idea for states, either (though he most likely thinks that the states should be allowed to have such a mandate, if they choose).  He criticizes the Massachusetts plan (Romney-care, I presume), which has a health insurance mandate and expanded the number of people on Medicaid.  The result is that "the waiting times to see a doctor in Massachusetts have nearly doubled", and a special commission recommended that state insurance conduct a cost-benefit calculation, which Perry calls rationing (page 83).

According to Perry, as Obama-care increases waiting lines (which I presume is because it drives up the demand for health care), and as government cutbacks result in fewer doctors, the result is health care becoming more expensive, especially as doctors quit due to Obama-care.  Moreover, for Perry, "the federal government spends money it doesn't have on programs that states, individuals, or private companies could likely do cheaper and better" (page 82).  Perry also does not like "the provision requiring calorie counts on all chain-restaurant menus" and "posting calorie counts on vending machines" because that will cost businesses a lot of money (page 85).

I think that Perry makes valuable points.  There are times in his book when his statements are pretty childish, but there are also times when he makes some pretty substantive policy arguments.  Here are some of my reactions:

1.  My impression is that the reason that waiting times are long in Canada (for certain procedures) and under Obama-care is that more people have access to health care, for they have the insurance that can enable them to see a doctor.  The goal should not be to tell people to get out of line (not that Perry says we should do that), but to increase the supply of health care.  There are a variety of ways to do this.  One way is not to make cutbacks that cause hospitals to close.  Another way is reasonable tort reform, since fear of being sued discourages people from entering or staying in the field of medicine.  A professor of mine suggested that medical students receive a free education.

2.  Health care costs have to be contained.  That's the purpose behind certain features of Obama-care that Perry criticizes: the insurance mandate, what Perry refers to as rationed care, and the requirement for calorie counts (since people who don't eat right cost the health care system money).  If health care costs are not contained, that will increase the cost of Medicare and Medicaid, and also the premiums that people and companies pay for private health insurance.  That in itself will put a clamp on the economy, perhaps more of a clamp than the regulations that Perry criticizes.  Perry's discussion of health care does not appear to manifest sensitivity towards this issue.  Granted, he laments that government bureaucracy is expensive, but he does not focus on ways to bring down costs.

3.  Perry criticizes government-rationed care, ignoring (at least in what I read) that private insurance companies themselves ration care, and in many cases do so for the sake of profits.  Howard Dean, a physician, pointed out one time that he as a doctor had an easier time getting things approved by Medicare than he did with private health insurance companies.  So who rations care more?  Moreover, while Perry is a critic of bureaucracy and paper-work, private health insurance companies impose a lot of that onto the system.  That's why advocates of a single-payer system argue that their system would reduce the amount of bureaucracy and paper-work that people have to deal with, since caregivers would have to interact with one payer, not multiple payers.

4 comments:

  1. Hi James, here (as elsewhere) you get into 'Economics'. I've just started looking at economic theory, specifically a book for undergraduates by Paul Krugman, 'Economics' with Robin Wells 2006 (which I selected because I saw a debate on TV with him saying austerity measures in Europe were wrong). Even in Krugman I find worship of the 'Free Market'. There is no such thing as a free market, and it's mythology of the 'invisible hand' that supposedly does wonders. Many people now are criticising the classical 'free market' model. Unfortunately, the politicians you are studying all seem to be fervent believers in the free market, and all they say is about tinkering with it. I find health care being thought of as best dealt with by a free market, even one tinkered about with, dreadful. The only way to do anything is to organise, and we should talk about different ways of organising things.

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  2. Hi Davey! I'm blogging about the Republican candidates right now, and I will be doing so for the next month or so. But I'm planning----after I finish Obama's autobiography----to read more left-wing authors, such as Robert Reich, maybe Paul Krugman. The thing is, as you note, even they are not in favor of scrapping the free market. They just want government involvement, and (in Reich's case), maybe unions. I can understand being against unbridled, laissez-faire capitalism, but I'd have problems with a total command economy. Is that what you favor, or am I misreading you?

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  3. Hi James, I think a viable culture needs creating for human beings. A film recently on TV here was 'Surviving Progress', available to view on You Tube (I don't know if all of it can be viewed, but see eg http://www.youtube.com/watch?v=4XX2BsleApY). Regards, Davey.

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  4. Thanks Davey. I think it will be important for me to watch that.

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