Wednesday, September 12, 2012

Howard Dean on Health Care Reform 1

During the past five months or so, I have read and blogged through books by Presidential candidates for the year 2012.  I blogged through Barack Obama's Dreams from My Father, and also books by Republican candidates Newt Gingrich, Herman Cain, Michele Bachmann, Rick Santorum, Ron Paul, Rick Perry, and Tim Pawlenty.  I also read a biography about Mitt Romney which struck me as rather sympathetic even as it acknowledged some negatives in his record.

From this point up to the election, and maybe beyond then, I'll be blogging through other books on politics.  My focus will be on the economy, but I will probably get into other issues as well.  The books that I will blog through are largely from a leftist perspective----think Howard Dean, Robert Reich, Arianna Huffington, George McGovern, and Paul Krugman.  But I will also blog through a book by Bruce Bartlett, an economist who served in the Reagan Administration who has written about the failure of Reaganomics.  I will get into the free trade debate, as I blog through a liberal book that promotes free trade, and a book by arch-conservative Pat Buchanan that is critical of it.  And, if time permits, I will blog through other books: a book by Lou Dobbs on the war against the middle-class, a book by Democrats James Carville and Paul Begala in 2006 about how the Democratic Party can improve its image, and a book by Sheila Suess Kennedy about how serving in the ACLU coincides with her Republican beliefs.

Some of you may have gotten tired of me plowing through books that extol tax cuts, less government spending on social programs, and free trade, even as they criticize public-sector unions.  Well, from this point, I'll be blogging through books that have a different perspective (though there will be cases in which a book may overlap with conservative ideas).  And, while I will probably be more sympathetic to these books that I am about to read than I was towards the Republican books, since I tend to lean left these days, I will still try to be rigorous in identifying what I consider to be the strengths and weaknesses in their arguments and policy proposals, as well as ask questions.

The book that I just started was Howard Dean's Prescription for Real Health Care Reform, by Howard Dean, Igor Volsky, and Faiz Shakir.  (But I will say "Dean says" or "According to Dean" rather than "Dean, Volsky, and Shakir say".)  There were a variety of noteworthy items in my latest reading, such as Howard Dean's discussion of his medical and political career, and what Dean says about the shenanigans of private health insurance companies.  What I want to highlight in this post, though, are four items.

First of all, Dean believes that health care reform is actually pro-business.  The reason is that health insurance costs businesses a lot, especially as health care costs continue to rise.  Dean says that this is why there are companies or plants that choose to locate in Canada rather than the U.S.: in Canada, the government pays for health insurance, and so the companies don't have to do so and can thus use their money for production.  I have some questions.  Do the high taxes in Canada discourage businesses as well?  Well, perhaps not, for the corporate tax rate in Canada was only 16.5 per cent in 2010 (see here).  At the same time, there is in Canada a 50% tax rate on realized capital gains (see here), and I wonder if that puts a clamp on the income that corporate people in Canada can make.  I also was curious as to whether Howard Dean's plan to pay for health care reform----which he defines as competition between private insurance companies and a Medicare-like program that would include all who want to join it----would encourage companies to leave the U.S.  Dean later in the book (I peeked ahead) endorses a carbon and gasoline tax as a way to pay for health care reform.  But remember the conservative argument that such a policy can encourage businesses that have a lot of carbon emissions to flee to countries where there are not as many restrictions.  Dean does not think that the taxes would be a problem, however, for businesses would love saving money on not having to provide health care to their employees, and people wouldn't mind paying a little more at the gas pump if health care costs were no longer as much of a problem for them.

Second, I appreciated Dean's discussion of employer-based health insurance.  According to Dean, employer-based health insurance is pretty good because, in big companies, a large number of people are contributing to the insurance plan.  Consequently, the insurance is reliable in the sense that it's there when the worker gets sick, and people aren't dropped for pre-existing conditions.  The problem is that, when people change or lose their jobs, they no longer are covered by the insurance.  Then, if they find themselves in a situation in which they are too young for Medicare and have too much money to qualify for Medicaid, they look for individual coverage----and that tends to be more stingy in terms of paying for treatment and even covering new applicants (who can be rejected for having pre-existing conditions, or poor credit, or whatever).

Third, Dean appears to think that there is a problem in some of the services that we pay for.  He states that other countries "hold down health care costs...by not performing as many procedures", and he says that "In Canada, for example, a coronary artery bypass graft (open heart surgery) is done one-third as often on a per-capita basis as it is in the United States" (pages 17-18).  According to Dean, this operation costs $60,000, and a Canadian study indicates that it doesn't even prolong life, even though it improves the quality of life.  Whereas, in Canada, a person with chest pains due to heart problems would "be treated medically for four to five years before undergoing surgery", in America people cut to the chase and get the surgery done immediately.  Dean states that this "is but one reason why our healthcare costs are more than 60 percent higher than Canada's" (page 18).  Dean makes important points here.  And yet, some may fear that rationing of health care could result from that sort of mindset, as bureaucrats decide which treatment is acceptable and which is not.  Private health insurance companies do so while keeping an eye on their profits, as Dean notes, but couldn't the government end up doing so while keeping an eye on restraining or cutting government spending in order to get rid of a deficit?  I should note, however, that Dean----like many others on the right and the left----is a proponent of health care reform that encourages preventative care, which could prevent people from having to get expensive surgery at the outset.

Fourth, Dean talks about what to do about people in their 20's who feel invincible and thus want to spend their money on something other than health insurance premiums.  Dean proposes that they be given health insurance for free, and he notes that they're inexpensive to insure, presumably because they don't have as many health needs.  Dean may believe that the government should provide that insurance, for he goes on to talk about how Vermont (where he was governor) offered health insurance to everyone under 18 in exchange for a "modest premium".  I wonder if Dean's plan would work.  I thought that one of the ideas behind the health insurance mandate was to have the healthy people in their 20s pay into the system, and that would take care of the sick people with pre-existing conditions.  But if the healthy people are not paying into the system, what happens then? 

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