Tuesday, July 28, 2009

Confusing the Terms of the Health Care Debate

Medical_symbol2 Martin Feldstein, a brilliant conservative economist, has his facts wrong on the health care debate in an op-ed he penned today in the Washington Post.

Nate Silver of FiveThirtyEight concisely explains Feldstein's error:

Take a look at this:

Obama has said that he would favor a British-style "single payer" system in which the government owns the hospitals and the doctors are salaried but that he recognizes that such a shift would be too disruptive to the health-care industry. The Obama plan to have a government insurance provider that can undercut the premiums charged by private insurers would undoubtedly speed the arrival of such a single-payer plan.

Feldstein is simply mistaken here. "Single-payer" has to do with who pays for health care (in the case of single-payer, the federal government does). It has absolutely nothing to do with who provides health care. It's the difference between the Canadian system, in which private doctors and hospitals are paid by the Canadian government (and indirectly, Canadian taxpayers) to provide health care to its citizenry, and the British system, in which the providers themselves -- doctors, nurses, hospital administrators -- are actually in the employ of Her Majesty's Government. For that matter, it's the difference between Medicare -- a single-payer system for American seniors -- and the British system. The Canadian system is nationalized health insurance. The British system is nationalized health care -- or if you prefer, socialized medicine.

Obama has never expressed or implied any admiration for the British system of socalized medicine. Not that there aren't admirable elements of it -- but I doubt that you'd find even very many self-identified liberals who would suggest that it's the right system for America. Obama, rather, has expressed admiration for a government-run monopoly on insurance -- single-payer -- as do about half of Americans in opinion polls.

Got it? Get it? Good.



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You're correct. Although Obama (or persons in his Administration) has used the words "British-style" in connection with his health reform proposals, it was to the "comparative effectiveness" element in the British system, not to the system as a whole. Further, as far as I know, Obama has publicaly endorsed a government-paid plan only as an alternative to private plans. But Feldstein is correct that a government-paid plan, where the premium paid by the insured could be subsidized by taxpayer dollars, would (or certainly could) drive private plans out of business.

Posted by: John St. John | Jul 29, 2009 11:00:27 AM

This seems to be a distinction without a difference. The current Medicare system, which appears to be the model that Obama is trying to replicate just does not wortk to address the underlying causes of health care cost increases. It's a 1960's style Blue Cross program where the only real control that is exercised is over the fee structure. And that's driving the providers out of the Medicare system.

Posted by: Rich Murdock | Jul 29, 2009 1:19:30 PM

Either way, the last thing we need is the federal government to mess up something else... Since when is Medicare an example of a well-run program? Give me an example of any federally-run program that is better than that provided by the private sector!

Posted by: Someone Who Cares | Jul 30, 2009 6:28:28 AM

The other arguments are fluff. National health care will bankruptcy the U.S. I've heard politicians say it will "revenue neutral". Huh? The real problem is how much this whole thing will balloon and expand once approved, if approved. You'll see the people in D.C. expand it beyond affordability within a year or two. You just cannot let govt control it, period. They only know excess.

Posted by: arizona carpet cleaners | Aug 12, 2009 9:51:08 PM

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