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.