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April 28, 2006

Round and Round We Go

Looks like I touched a nerve with Dale Franks, because he just released a 2,500 word blast on the infeasibility of universal health care which is, quite literally, one of the strangest things I have ever read. I've not got time to respond to the whole thing, but a few points:

• The French pay their premiums through payroll taxes. We pay them through bills. Franks does some math with this that genuinely made me want to bang my head into the wall, concluding that "what is troubling about the French system is the cost" because "payroll "contributions" for health insurance would have to increase by 73%." I could go into the multifaceted, deep reasons it's wrong -- there's the issue of implicit vs. explicit taxes, for instance -- but let's do this the simple way.

The question at hand is total money spent because, in the end (and a libertarian like Dale should know this), the cash is basically all coming from the same pot. Whether you call it a payroll tax or a premium doesn't matter, the issue is how much money you've got left at the end of the day. The French spend $2,900 per capita on health care, and that covers every member of their citizenry. We spend $5,600, and we leave 46 million out in the cold. If you somehow think the former is more expensive than the latter, you're practicing what Tom Lehrer so aptly termed "the new math," and should really just let me know when you've descended back into the realm where basic mathematical concepts come into play. Then we'll talk.

• Dale doesn't like the American system. He prefers it to the French system, but he doesn't like the American system. He wanted you to know that.

• He writes, "the French medical system isn't a bad one by most standards." Well that's certainly true. Take the World Health Organization's standards, which rank the French #1, and the US 37. Or take health outcomes, where they beat us across the board. Or take cost, or percent of population covered, or system responsiveness, or patient experiences, or pharmaceutical prices. So yeah, by most standards, the French system isn't bad. In fact, by quite a few, it's the best. But the American system, which Dale prefers, is loathsome.

• He asks how I can recommend the French system when Medicare has an unfunded liability in the trillions. This would be one of those times when we need to explain the difference between socialized insurance and socialized medicine. For a more accurate comparison, let's look at the VA's cost balances and outcomes. And if we don't want to do that, let's look at how America spends twice as much per capita than any socialized system in the world, despite lacking full coverage or better health outcomes.

It sort of goes on like this, descending into blather about the "true" meaning of the word insurance and attempting to explain why America's high costs are are the guvmint's fault. If you want to read it, you can. In the end, though, this argument isn't complicated, though Dale is trying to make it so. Every other industrialized country in the world has nationalized health insurance. Every other industrialized country in the world covers all its citizens. Every other industrialized country in the world pays around 50% what we do. And most every other industrialized country gets better health outcomes than us. As the journal Health Affairs put it:

In other developed countries, experience has repeatedly demonstrated the superior capacity of more-universal social insurance programs to restrain growth in overall medical spending. Any comparison of growth in health spending of the United States and social-insurance nations like Germany, the Netherlands, and France would show that U.S. spending has grown more rapidly in recent decades. And these are countries with both older populations and more widespread use of health care than is the case in the United States.

And that's what Franks, even in 2,500 words, simply can't explain away.

April 28, 2006 | Permalink

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Comments

Franks sez: Once we get into the business of defining rights as "whatever we all agree you should have", then there aren't any rights at all.

Libertarians seem to have some difficulties on rights and where they come from.

Last time I checked, the US Bill of Rights was created by Constitutional amendment, voted upon by the states, when they all agreed on the rights we should be guaranteed.

And when that wasn't enough, as we found out through experience, we added some more rights by amendment to provide for female voting, Constitutional rights being extended to the states, and several others. All by agreement by the people through their representatives, not delivered to us by the CATO Institute or some vague Nature's God.

Posted by: JimPortlandOR | Apr 28, 2006 11:50:51 AM

The whole thing is tons of deranged fun:

And, of course, once you hit 65, you're on the health care gravy train, because you've got your Medicare, which the government does pay for. And now, it pays for prescription drugs, too.

HAHAHAHAHAHAHAHAHA!

1) Eliminate the tax breaks for employer-provided health care. This would force employers out of the health coverage business. Since employee salaries would still be covered under corporate tax law, employers could transfer that money into direct compensation.
2) Change private health insurance purchases to pre-tax expenses for individuals, so that the whole cost of health insurance can be written off. Voluntary contributions for covering the medical care of the poor and indigent can be written off at triple the amount contributed. Insurers who contribute to medical coverage for the poor and indigent may be written off at the same rate.

See, the federal government is losing all sorts of money because of tax-breaks for employer-provided healthcare (an argument he made earlier in his post). The answer to that is to provide tax-breaks for individually purchased healthcare, which will somehow result in billions of dollars for the federal coffers and lower premiums for consumers since they're participating in a "free market."

Oh, and let's fund the cost of care for the poor out of the goodness of people's hearts, because that's working so damn well right now. Let's see, if I give $2500/year to fund insurance for poor people, that gives me a deduction of $7500. Wow! Of course, the standard deduction for my family is $10,000, so screw that. No money for the poor this year, I guess.

Finally—and this is the last bit—Ezra Klein, and others posit that health care is a "right" because we have all agreed that it is. This is, perhaps, the most outstandingly foolish argument I can imagine. By that reasoning, if we all decide that you don't have freedom of speech, then it isn’t a right any longer.

Hmmm. That's called democracy, I think. I'm pretty sure that the Bill of Rights is a portion of the Constitution that was drafted, debated and passed by people who all agreed that these were good rights to have, and so they granted themselves these rights, when they had not existed before. A foolish argument is trying to make something like freedom of speech more akin to gravity than to a creation of particular people at a particular time.

The only conclusion I can reach is that Franks hasn't got the slightest idea what he is talking about.

Posted by: Stephen | Apr 28, 2006 11:55:55 AM

The Employer pays 12.8% of payroll for URSSAF. The employee pays 0.8% of payroll to URSSAF, and 5.1% to the CSG. Sure, you can go to a doctor's office for €7 or so, but that isn't the cost you're paying. Think about it: Out of whose pocket is that 12.8% employer "contribution" coming from? Hint: It isn't the employer's.

Whats the difference between that and my current paycheck. 6% of my paycheck goes to my health insurance. I don't actually know how much they pay, but I'm sure its more than that, although admittedly probably not double. Looking past the difference in total contibutions though, how is it that the URSSAF contribution isn't similar in concept to my employer's contribution to Harvard Pilgrim?!?

Posted by: Adrock | Apr 28, 2006 12:44:31 PM

The Employer pays 12.8% of payroll for URSSAF. The employee pays 0.8% of payroll to URSSAF, and 5.1% to the CSG. Sure, you can go to a doctor's office for €7 or so, but that isn't the cost you're paying. Think about it: Out of whose pocket is that 12.8% employer "contribution" coming from? Hint: It isn't the employer's.

I hear this all the time from "libertarians", and I always ask myself: "Do they seriously think that an employer, freed from [insert tax constraint here] would actually pay the rank-and-file their share of that eliminated cost? Have they actually worked for a corporation?"

Posted by: paperwight | Apr 28, 2006 12:49:56 PM

Ezra Klein, and others posit that health care is a "right" because we have all agreed that it is.

Well, actually I agree with him here. We haven't all agreed that it is a right, if we have there would be little argument over it. But we believe that it should be. Thats a difference in political platforms between us and Franks and why each of us approaches the topic with different sets of assumptions and goals. The only other question is which platform wins at the polls.

Posted by: Adrock | Apr 28, 2006 12:52:39 PM

I don't know that I think it a "right" so much as something government should universally provide. I don't think Social Security a right, I just think it the sort of thing government should do. Which is to say, all this rights talk strikes me as a red herring.

Posted by: Ezra | Apr 28, 2006 12:58:34 PM

I always think of it from a return-on-investment point of view. If you pay amount "x" on a social problem, you won't have to pay larger amount "y" to clean up the problems that lack of adequate social coverage causes.

Posted by: William Bollinger | Apr 28, 2006 1:26:49 PM

Which is to say, all this rights talk strikes me as a red herring.

Libertarian "rights" generally amount to the reification of white men's property advantage, complaining that everyone who's not them is "inventing new rights" while the "property rights" they worship are of course completely natural and not made up at all.

Posted by: paperwight | Apr 28, 2006 1:27:43 PM

"That's called democracy"

Actually, this is where the "Republic" part comes in. And Dale did have a good point about us raising hell regarding abortion, etc. It was the supreme court that created that right, via the also currently unvoted on "right to privacy", and we are ticked off when recently, certain states try to (virtually) ban it by vote.

Have you heard of "the Tyranny of the Majority"? This was his point on the subject.

Yes Dale missed some points, (like the lost revenue in taxes, but then saying indv health care should be tax free) but he had some good ones as well. (In particular, I think the observation that "Rationing is a fact of life" was insightful and correct.) On the whole I was impressed with his respectful tone. There was some snark, but again -this quote:
"It's no wonder that more and more people are looking at single-payer, government-provided health care as an alternative to what we already have. At the very least, a single payer system would end the inefficient and fragmented ways by which health care is currently purchased."

Ezra, the back and forth between you and Dale on this has been, by far, the most useful, reasonable debateon the subject I've seen. I really hope it stays on topic and doesn't devolve into attacks.

Posted by: Tito | Apr 28, 2006 1:28:14 PM

"That's called democracy"

Actually, this is where the "Republic" part comes in. And Dale did have a good point about us raising hell regarding abortion, etc. It was the supreme court that created that right, via the also currently unvoted on "right to privacy", and we are ticked off when recently, certain states try to (virtually) ban it by vote.

Have you heard of "the Tyranny of the Majority"? This was his point on the subject.

Yes Dale missed some points, (like the lost revenue in taxes, but then saying indv health care should be tax free) but he had some good ones as well. (In particular, I think the observation that "Rationing is a fact of life" was insightful and correct.) On the whole I was impressed with his respectful tone. There was some snark, but again -this quote:
"It's no wonder that more and more people are looking at single-payer, government-provided health care as an alternative to what we already have. At the very least, a single payer system would end the inefficient and fragmented ways by which health care is currently purchased."

Ezra, the back and forth between you and Dale on this has been, by far, the most useful, reasonable debateon the subject I've seen. I really hope it stays on topic and doesn't devolve into attacks.

Posted by: Tito | Apr 28, 2006 1:28:15 PM

I don't know that I think it a "right" so much as something government should universally provide.

Not that it's ever worthwhile to argue this point with libertarians-- who apparently would all manage to provide themselves with the accoutrements of civilization using only a moderately extensive personal library and their bare hands, if only the government would get out of their way-- but the argument is that government can simply ensure access to certain benefits of modern life more efficiently and fairly than individuals or their beloved "free market." Decent roads aren't a "right," and neither are public universities, but they are generally beneficial.

And the Bill of Rights is not the only part of the Constitution that addresses the functions and/or limitations of government-- these guys might want to try reading the Preamble once or twice, with particular attention to how the stated objectives of the document can overlap, as well as thinking a bit outside their very narrow conceptions of "common defense" and "blessings of liberty."

Posted by: latts | Apr 28, 2006 1:31:21 PM

And that's what Franks, even in 2,500 words, simply can't explain away.

Puh-leaze. It only takes two words to disprove everything you said:

France sucks!

'Nuff said. USA! USA! USA! (never forget)

Posted by: Captain Republican | Apr 28, 2006 1:57:55 PM

Personally, I'd rather see the states do health care. I'm not too eager to enact a single program for 300 million people that will be very difficult to change.

Posted by: Adam Herman | Apr 30, 2006 12:47:45 AM

Let's not let "framing" of positions get away unscathed.
Calling the debate one on "rights" is bafflegab of the purest water. On having systems which work to best advantage for the public at large is a whole 'nother kettle of fish.

Posted by: opit | Apr 30, 2006 5:15:02 PM

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