Archives for: July 2012, 02
In Response to T. Paine's Cynical Constitutionality of Obamacare
When one adds 30 million more people to the health care roles and then provides HUGE disincentives to current doctors and future would-be doctors, you tend to get a whole lot more of a demand with a drastically shrinking supply of medical service providers.
- T. Paine, June 30, 2012
Shortly after Medicare was passed. An acquaintance was explaining his opposition to providing care to the elderly. It was based on personal experience. He had stopped to get a prescription filled and had to wait, losing precious time, while an older person in line got pharmacy paperwork complete. His day would have gone more conveniently if he hadn't had to wait for some elderly person to get their medication.
Continuing friend T. Paine, the T. Paine who sends prayers and encouragement about the tour of our young Marine in Afghanistan, the T. Paine who disagrees but never disagreeably, writes in opposition to Obamacare. His opposition is partially, and unintentionally, counter-factual. It is partially speculative, and counter to more informed studies.
But factual mistakes happen with passionate advocacy and limited time. And speculation, even speculation that challenges the most diligent of studies, is fair.
The part that is factual, accurate, and speculative in a way that would provoke agreement from pretty much everyone, does reveal a basic departure of values. And, I suspect, is typical of core values of Republican opposition.
The "HUGE disincentives to current doctors and future would-be doctors" is argued against by the American Medical Association. The AMA has been a driving force in favor of Obamacare. Doctors support Obamacare. Yeah, those same doctors T. Paine speculates will leave the profession. The AMA is also lobbying for a simpler record system and for upward correction of payments to doctors for Medicare and Medicaid treatment. The only resistance to those corrections has come from Republican opponents of Obamacare. It's another case of Obamacare-is-bad-because-of-all-the-difficulty-we-cause.
The dramatic increase in medical costs that T. Paine imagines would be produced by lower supply, because of the imagined uncorrected incentives driving Doctors out of medicine and into ... I dunno ... engineering maybe, and higher demand, all those pesky uninsured who will now get healthcare. Lower supply and higher demand is the classic Adam Smith formula for increasing costs.
The demand side problem with T. Paine's economic speculation is that he compares the projected world of full medical care for everyone who needs it, with the world he wants, his desired world of great numbers of desperately ill people with no medical care. In fact, many people, not all but many, who cannot afford medical care, get that care anyway. Back when I volunteered after work in a local Emergency Room, I never saw anyone turned away for financial reasons. ERs operate that way across the country. People who are uninsured do get billed for treatment, but vast sums are eventually written off. Blood from a turnip and all.
Those costs, which come from those willing, for financial reasons, to get medical care only when desperate conditions become critical, end up going to everyone else. Insurance costs go up. Medical costs go up. Everyone who has insurance pays this hidden tax and we do it now.
The non-partisan Congressional Budget Office conducted a major study with the Joint Committee on Taxation. Here is what they say (pdf):
Premiums for employment-based coverage obtained through large employers will be slightly lower than they would otherwise be; premiums for employment-based coverage obtained through small employers may be slightly higher or slightly lower.
That's on page 8.
This also has an effect on the federal deficit:
CBO and JCT effectively estimated in February that PPACA and the health-related provisions of the Reconciliation Act will produce a net decrease in federal deficits of $210 billion over the 2012–2021 period as a result of changes in direct spending and revenues.
You'll find that on Page 3. A chart, showing year by year projections is on page 4.
But the value system that T. Paine espouses, as I see it, is the defining difference. T. Paine is willing, even eager, to throw millions of people out of any health care, as he imagines a world in which Emergency Rooms turn away injured or desperately ill people with no treatment.
So my friend T. Paine:
Is on factually inaccurate ground when he says doctors will leave the medical profession in droves, reducing medical care for those who can get it. The AMA backs Obamacare.
Is on speculative shaky ground when he thinks health care costs will skyrocket by providing treatment to those who go untreated now. In fact, earlier, less expensive care to those who now make it to emergency rooms for expensive treatment, will no longer increase costs for the rest of us. Deficits will go down. Health care costs will go down.
- Is on sandy moral ground in seeking to benefit by throwing people out of treatment in order to reduce the numbers of those being cared for.
"There is a reason," says my friend T. Paine, "why the wealthy citizens living in countries with socialized medicine come to the United States for their treatment."
And if it takes millions of Americans going without treatment to maintain an exclusive atmosphere for those wealthy guests, well hey.
Life is filled with little tradeoffs.