Tuesday, July 24, 2012

A Real Liberal Health Care Bill

Signing a bill that still won't cover everyone and will drive up costs.

I have wondered why liberals have allowed the Democratic party to destroy their good name over health care. If you look at the goals of liberals in the health care debate and then look at the result of the health care law, the two couldn't be further from each other. So I was thinking about the health care law I would pass if I were a liberal. These would be my liberal goals.
  • Ensure everyone can afford health insurance.
  • Ensure that those with pre-existing conditions are covered.
  • Reduce the cost of health care to the average American.
  • Ensure that any law doesn't reward corporations at the expense of taxpayers.

We might debate the wisdom of these goals; but if this were the liberal position, I could respect that. We could write a pretty simple health care law, not a 2700 page monster. The key policy prescriptions:

  • Provide a federal subsidy for the "working poor" to buy health care if they lack it. Continue to use Medicaid for the rest of the poor.
  • Make insurance portable between employers, so those with pre-existing conditions can keep their insurance when changing jobs.
  • Provide a subsidy for those with pre-existing conditions, if they haven't already obtained insurance.
  • Subsidize college education for doctors and nurses, reducing price by increasing supply.
  • Limit the ratio of administrators to doctors at hospitals and reduce paperwork needed for doctors, reducing price by reducing cost.
  • Create a special H-1B visa category for doctors, nurses, physicians assistants, and nurse practitioners, to increase the supply of providers, reducing price by increasing supply.
  • Don't have an individual mandate or any of the other sops to various insurance and big pharma lobbies.
  • Allow the re-importation of drugs from countries where price controls artificially reduce their cost of drugs at the expense of Americans, reducing the price of drugs.

Nowhere in this plan would a good liberal mess with what was already working for most Americans, who were generally happy with their insurance prior to the ACA.

When the dust settles on this statute, if it is not repealed, there will still be a significant portion of Americans who will lack health care coverage. Amazing. 2700 pages and the Democrats masquerading as liberals couldn't manage to cover all Americans for health care. They also increased the costs, and caused many Americans to lose their employer provided coverage. I await a liberal response as to how this furthers the ends envisioned by liberalism.


  1. You forgot reforming doctor liability insurance. Its a major killer for many doctors.

    You've forgotten the evolution of this bill. Carebear went into it trying to gain bipartism support by embracing all the previous Republican proposals he could find. He ruled out single payer from the beginning. He tried everything in to the big insurance companies because that is who killed the Clinton proposal. So from the very start this bill looked like a Republican proposal from 20+ years ago. From there it became a Frankenstein monster of patches and pandering. All in an attempt to get some Republican support. So largely it looks like the mess it is because Obama was trying to get Republican and Blue Dog Democratic buy in.

    Dims support it now because its all they got, and it does have a few useful features such as rules about preexisting conditions and providing coverage for adult children. The real left was never happy about it. In fact there were some on the left that wanted it to be struct down so that a better proposal could be put forward.

    I agree with you that it does nothing to control costs and therefore is a ticking time bomb. But realistically the only way to really control costs is some sort of single payer system. That doesn't have to mean the flawed the British/Canadian system with rationing. It could follow the German model.

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    2. Kelly, thanks for providing liberal commentary. I agree that he pandered to insurers to get votes, but really, given his majorities at the time, is that any excuse? Also, the Republicans today are a different mix than 20 years ago. I think that former Libertarians and strict constitutionalists are much more influential in the party.

      I don't want to control costs of health care, because I lack the hubris to believe that there is a correct amount of spending on health care. I think that if consumers shared more of the costs, then we could reduce the unit costs of health care, even if we spent more. I spend more on technology and software today than I did 15 years ago, because I buy more units (I am now at 5 computers, 3 smart phones, 3 internet enabled game systems and a four box internet enabled sound system in my house.) The unit cost of these items all went down, allowing me to buy more and in fact spend more in total cost on technology. The same could happen with health care. See my article on Bending Down the Cost Curve. Reduced unit costs for drugs might increase overall spending on health care, especially if people lived longer. My beef with the ACA is that it seems to increase unit costs. The key to controlling unit costs is consumers bearing part of the cost of health care.

  2. Call me a dreamer, but I still hope and wish that one day we could all afford to have health insurance or if not all of us, the majority of the people. Health is something we need not to ignore. Without health, all the money we have is worthless.

    1. Tina, I agree and thank you. I don't want to confuse health care with health insurance in this discussion. Administrative costs make doctors unaffordable, for example. Less lawyers and administrators and more doctors would help.