Healthcare: the Liberal Grand Strategy

When it comes to healthcare, liberals have an end game. They are patient. And they are willing to coordinate a grand strategy at the federal, state and local levels. That endgame is socialized medicine. They are using incremental means to get there. The strategy is this: slowly destroy whatever is left of the insurance market - piecemeal - until citizens demand that the whole system be scrapped. All the while, they will insist the failure is one inherent in private insurance, rather than in the distortions and problems caused directly by state regulation.

In this grand strategy, Medicaid and Medicare are the foundations – the given. Medicaid is for the very poor. Medicare is for the old. Each represents state provision of healthcare at the bookends*. But there is the population in between that is covered by the heavily regulated (but still private) insurance market. That market is more a series of isolated, state-locked, protected monopolies than a market, but it is still private. In any case, if you want socialized medicine, how do you make the current system even worse? 

Find wedges that drive a "death spiral"—i.e. the vicious circle of prices going up resulting in the slow deterioration of the private healthcare market. One example of such a wedge is “children.” First they called for Medicaid for all poor children. Now they are calling for Medicaid for all middle class children. Soon they will call for universal healthcare for children (nevermind this apparent distinction). And children will be defined very broadly (in some states up to 26 years of age). So why children?

Politically it is difficult for anyone to deny any proposal offered in the name of children. Moreover, children are low risk because most are young and healthy. If you remove children from the insurance risk pool, older, sicker people remain. Since expanding Medicaid to children means removing more and more children from the risk pool, premiums of the remaining older, sicker people will go up, because that group is riskier. Soon the premiums get so expensive more people—particularly “young invincibles” opt out and cry out. They don’t understand the political machinations that got them to this point, only that insurance is too costly. Soon politicians will offer to take away their pain in exchange for government control of healthcare. Right now we are in the stage where people are crying out. “45 million uninsured” they cry, or simply “we can’t afford it.”

When you couple the incrementalism of children being lured from the risk pool by expanded Medicaid, the addition of costly state coverage mandates, and many other regulatory cost-drivers, healthcare becomes a vice designed to tighten the population until the population submits. Submission is socialization. That’s it. That is the grand strategy and the end game and it must be stopped. Socialized medicine – arrived at piecemeal via the political use of children – will offer us much less than people might wish for. Socialized medicine is a system that cannot exist without rationing, waiting lists, the denial of choice, and tax increases the likes of which we’ve never seen.

Am I being overly conspiratorial? You be the judge.
-Max Borders

Comments

[Ray Hooker]

First let me say respectfully that there are some conservatives who have looked at the facts and know that we need an approach similar to what the Democrats are proposing. Let also correct your characterization that Medicare/ Medicaid is at the margins. It is the most expensive part of health care, but it was easier to sell at the time.

My point is that you need to get your facts straight. We in the US spend twice as much as the rest of the world with often poorer results. Though we have the best technology and acute care in the world, that does not always equate to better health.

Finally the proposal is not to destroy the insurance system. You only have to have a son with Leukemia or run into another life changing or chronic condition to begin to see the problems. It is not a conspiracy, and it is not liberal. It is a studied approach to help reform our system, an approach which needs a national plan, something none of the candidates of my party (Republican) are offering.

[Max]

I must respectfully disagree with you, as well, Ray. While we spend more than the rest of the industrialized world on healthcare (no it is not twice), the reason for that is largely overconsumption. People go to the doctor for sniffles. They buy viagra, expensive - but often unnecessary - meds when they could get generics. They get unnecessary testing. They even spend massive suns to keep people in vegetative states who have no prospects of life or quality of life. Wait, did I say "they"? What I meant was the insurance pool: we. If we didn't have third-party pre-paid healthcare and treated health insurance more like car insurance, we would have less overconsumption (and thus we'd fall into line with the rest of the world in per capita spending for healthcare).

[Max]

One additional note: I should not have characterized Medicaid or Medicare as at the "margins" (I was trying to evoke a mental graphic more than an economic chart. You are right, they are certainly gobbling up much of the spending--and also drive overconsumption mentioned above.

[Ray Hooker]

I can clearly see the angst among many of my fellow conservatives. I actually am lobbying against the visceral reaction and for a more studied appproach. I don't think there is any conspiracy here. I think there is an honest concern. I have had many heart to heart conversations with fellow conservatives who have been confronted with the issues of our current health care/ insurance system. Most of them still hold to conservative principles but reality has made the realize change is needed.. on a national basis. Unfortunately when the try to discuss the matter (at least in the past), many cry "socialism" and end the conversation.

Ray

P.S. - The son with leukemia was ours.. though fortunately he is doing well. Yet he is shut out of normal healthcare policies...if he ever lost his great job with a group policy or went independent..

[Max]

Ray,

I'm sorry to hear about your son. But I'd like for you to consider this: why should your son or anyone have to get insurance through his employer? The answer is the tax code, which unfairly rewards employer-based insurance. But that makes it non-portable. If the tax code made it such that people received the same tax benefit buying on the individual market, we'd never have to worry about people keeping their jobs to keep their insurance. This, again, is the fault of government, not the market.

[Ray Hooker]

Max, Thanks for your comments. We are grateful that he is doing well.

Changing the tax code is very good, but it will not solve the problem. The issue is that the risk profiling will price him out of the market. Even risk pools will not fully address the issue. In fact many people have to work for a big corporation in order to shield themselves from risk profiling. This is the "fault" of the market.

You only have to look to countries like Germany where private insurance is dominant but much more regulated and restricted that anything in the US. I believe we need an entitlement baseline plus reforms to make private insurance workable.

Also the HCA are not a solution without many other changes. For example most people are poor consumers of medical services. Even if there were perfect, the inability to determine the price for a service and to access discounted prices. Cigna can bully providers but not the individuals who will pay twice as much...

Ray

[Max]

If someone has insurance, and doesn't have to worry about portability, then coverage isn't so much an issue -- even if they turn up with a chronic condition. So, as a conservative republican, would you propose that people in chronic conditions bypass the risk pool and simply be taken care of by the state?