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March 17, 2006

If You Can't Beat 'Em, Misrepresent 'Em

The usually good Michael Kinsley ignored his better angels yesterday and turned in a truly muddled effort attacking Paul Krugman and Robin Well's recent health care manifesto (full disclosure: I'm mentioned in the piece). Kinsley's article is sold as a defense of "modest reform" against "single-payer," which he achieves by ignoring the range of single-payer systems and, like so many others, stereotyping single-payer as Canada. His main complaint is that he fears rationing and, moreover, the inability of rich people to escape it, and thus demands that private money be allowed in purchasing health treatments, and fears that it won't be within the Kurgman-Wells, which is to say single-payer, context. As if to signal the coming misdirection, he even notes that Clinton's plan fell amidst fears that consumers would not be able to buy their own care. What he doesn't mention is that those fears came from Elizabeth McCaughey's viciously inaccurate article No Exit, which was published at the magazine Kinsley used to edit, The New Republic, and which that same magazine formally apologized for last week.

No Exit was so effective because it quite convincingly argued against something that didn't exist. The central claim, as in Kinsley's article, was that ClintonCare would deny individuals the ability to obtain treatment with their own money, leaving "no exit" from the system. This was in flagrant violation to one of the first provisions of Clinton's bill, which stated:

“Nothing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services.”

Similarly, Krugman and Wells write:

In summary, then, the obvious way to make the US health care system more efficient is to make it more like the systems of other advanced countries, and more like the most efficient parts of our own system. That means a shift from private insurance to public insurance, and greater government involvement in the provision of health care—if not publicly run hospitals and clinics, at least a much larger government role in creating integrated record-keeping and quality control. Such a system would probably allow individuals to purchase additional medical care, as they can in Britain (although not in Canada).

Yet Kinsley picks up the same old tactics to, in violation of their own words, argue that Krugman and Wells support a closed socialism, and thus inescapable rationing, they expressly deny. Moreover, even if they supported such a scheme, I'd be surprised to learn that it would prove constitutional to fully nationalize health care treatment, a move fully unheard of in our economy. As example, in America, we have a single-payer defense system, the military. That doesn't mean, however, that wealthy individuals can't spend their own money seeking luxurious private defense, hence the flowering of military contractors, mercenary organizations, and bodyguard suppliers. The public-run defense is the core, but the rich can seek out boutique defenders if they so wish.

No seriously considered single-payer proposal I know of argues for anything different in American health care and, indeed, amongst the government-run systems of other advanced countries, the ones Krugman and Wells want us to emulate, private care has exactly the second-tier role Kinsley is hoping for. What's confusing, at least to me, is why he felt the need to discredit Krugman and Well's argument by reading in a prohibition that isn't there.

Cross-posted from Tapped

March 17, 2006 | Permalink

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Comments

Would it be appropriate to say that Kinsley is quirky (the kindest word I could think of than means defiantly contrarian)? These days contrarian means you don't have to tell the truth.

Posted by: JimPortlandOR | Mar 17, 2006 11:07:03 AM

I'm waiting for single-payer big government solutions for auto insurance, myself. With so many uninsured motorists...

Posted by: Fred Jones | Mar 17, 2006 11:50:19 AM

I think our government should undertake the 80% of care that comprises 20% of health care spending. The kind of preventative (flu shots, innoculations, pre-natal care, fixing broken bones etc) care that on average, everyone needs. People would just go to their doctor (or hospital) get their shot or half dozen stitches (in the case of a cut) and go home. Both parties would report the procedure (like we do with taxes) to the government. The insurance billing and paperwork savings alone would probably offset any added government expense. We should have an Internal Medical Service review and audit doctors and hospitals to limit fraud and abuse.
I think that employees (and employers) would want to continue to buy and carry insurance for more costly health emergencies and/or chronic conditions. People would then be able to buy different levels of coverage (I'm envisioning dozens of levels) to suit their lifestyle/budget. Each particular condition is relatively unlikely so extra coverage shouldn't be too expensive. In other words, if I'm a smoker, I'd buy extra lung cancer coverage; if I'm a ballet dancer, I'd buy extra arthritis/joint replacement coverage. If I'm a car racing nut/speed demon I'd buy extra organ/limb replacement coverage. You get the idea...
OK so what about chronic/genetic diseases that have no lifestyle component? Same thing, you would buy coverage for that disease/condition either individually or through work. If you know (or think) you are at risk for something, you set money aside to pay for insurance for it (just like you put money aside for attending a private collage). Yes this system involves people making trade-offs, maybe you forego a bigger house to pay for your health insurance, or you keep your car a couple more years before you trade it in. Some people will decide not to pay for extra insurance at all (44 million americans are already doing this...). When they get sick what will they do? Basically what they already do...turn to friends and family, church groups, foundations or charity for the money to fund their care, if that doesn't work...tough luck, they made their choices, make the best of it, we all die eventually. Is this harsh? probably. But at least it is a feasible, economically rational system.

Posted by: daniel | Mar 17, 2006 12:00:39 PM

Nice piece. I'd replace the defense analogy though because bodyguards and the like are a different sort of good than is the air force. How about the postal service? Everyone can send mail but if you want it there quicker, call Federal.

Posted by: quietstorm | Mar 17, 2006 1:51:11 PM

Fred: If you're actually going to argue that health insurance and auto insurance are equivalent, then go ahead. Good luck.

Daniel, there's a big problem with the scenario you lay out, which Ezra has described pretty clearly before. Insurance works by pooling risk. If only high-risk people buy insurance for particular situations, then the cost of that insurance will rapidly approach the cost of the care itself.

Posted by: jackd | Mar 17, 2006 8:02:00 PM

Fred: If you're actually going to argue that health insurance and auto insurance are equivalent, then go ahead.

Isn't it amazing that the state has no problem forcing you buy auto insurance through the threat of jailtime and fines, but not health insurance. Lack of either is detrimental and unfair to those who *are* insured. Lack of either can result in catastrophic financial hardships. At the very least, a means test could force those who can afford it into the system.
The assumption that *all* of the people that are not insured cannot afford health insurance is a bogus one. The auto insurance model has proven that. It was amazing how many people all-of-a-sudden could afford auto insurance when jailtime was the alternative!!

Hey, jackd....there's tree over there behind the forest!

Posted by: Fred Jones | Mar 18, 2006 9:47:12 AM

Freddy-boy, the difference is that most automobile accidents affect at least another party unless you have an accident on your own property with your own car, while someone unhealthy isn't a risk to others unless they're spreading what used to be called a 'dread disease' in common nomenclature.

Posted by: The Dark Avenger | Mar 19, 2006 3:16:46 AM

What a load of bullshit.
There is absolutely no reason why you can't means test and force those who *can* afford insurance to buy it, just as we do with auto insurance. It is a fair move and one that is easy to legislate and would mitigate the problem we have now.

Posted by: Fred Jones | Mar 19, 2006 9:41:31 AM

"There is absolutely no reason why you can't means test and force those who *can* afford insurance to buy it, just as we do with auto insurance."

The difference between auto insurance and health insurance is that if you decide you cannot afford auto insurance you can make the choice not to drive.

If you cannot afford health insurance (or even worse cannot obtain it due to high rates or denial of coverage - "pre-existing conditions" etc.) you CANNOT make the choice not to get sick.

The worst problem with a private health insurance option in my view (for those who are covered at least - i.e. ignoring to 40 million uninsured) is that you can be a good citizen - have private insurance through work or independantly and then loose your coverage when you get so sick that you cannot work/earn.... i.e. just when you need it most. Also if you loose coverage - even for a breif period - you may not be able to obtain/afford new coverage due to your "high risk" - private health insurance works great as long as you are heathly (or very wealthy)!!!

I would be very interested to know the solution proposed by privavte insurance advocates to this problem?

A single payer option IS "forcing those who *can* afford insurance to buy it" (everyone who pays taxes) without the ridiculous overhead of means testing and trying to verify that people do/do not have private coverage before forcing them to buy it.

Posted by: terry oc | Mar 23, 2006 3:22:35 PM

A great post! The subject called insurance is something very complicated. Fortunately I collide with it only when my car is concerned.

Posted by: michael jones | Aug 20, 2007 9:12:56 AM

So wait - you provide evidence that the act would not have prohibited individuals from purchasing health care services directly.

Would it have prohibited individuals from purchasing health care services indirectly, through private insurance schemes? Or would it have banned private insurance schemes?

Posted by: Fluffy | Oct 10, 2007 3:49:28 PM

There is absolutely no reason why you can't means test and force those who *can* afford insurance to buy it, just as we do with auto insurance. It is a fair move and one that is easy to legislate and would mitigate the problem we have now.

FreeInsurance

Posted by: Matt | Oct 18, 2007 3:25:56 PM

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Posted by: peterwei | Oct 22, 2007 6:53:10 AM

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