Tuesday, August 25, 2009
Indiana University on health care reform "myths"...
If you dispute Obama’s claims about what Democrat proposals for health care will do, you are believing "myths." Or so says Dr. Aaron Carroll of Indiana University's Center for Health Policy and Professionalism Research (CHPPR), who observes "It's perhaps not surprising that more Republicans believe these things than Democrats. What is surprising is just how many Republicans - and Independents - believe them. If the White House hopes to convince the majority of Americans that they are misinformed about health care reform, there is much work to be done."
Noting the quotation marks that the article repeatedly uses around "myth," let’s take a quick look at the "myths" mentioned:
"wait times for health care services, such as surgery, will increase"
This would almost certainly happen. The primary means of controlling the growth of total health care spending will have to be to reduce services with these proposals. The proposals call for cutting prices paid to M.D.s and hospitals. This would result in less, not more service. At the same time, we'd expect quantity demanded to go up, because of lower prices and more people covered. There would be more waiting, just as in the U.K. and Canada.
"the federal government will become involved in making personal health care decisions"
What is any of this, if not the federal government becoming involved in making these decisions? The federal government would mandate minimum coverage, as well as pricing and availability of services. This is an attempt to do it en masse, for all of us. And under such a system, developing a set of recognized best practices would likely become a system of covered or allowable practices, established by the government.
"taxpayers will be required to pay for abortions"
Health care specific to women is included in the proposals, and those who cannot pay for their own would be subsidized by taxpayers. Unless a specific exception were written in for abortion, it would be covered.
"reforms will result in health care coverage for all illegal immigrants"
By law, illegal immigrants already have access to health care in the United States. Unless reforms specifically strip them of this entitlement, there would still be coverage for them. Incidentally, the economic argument for providing insurance to the uninsured is that it will supposedly reduce the total cost of providing care to the uninsured, since they rely heavily on more expensive emergency care. This argument holds regardless of the uninsured’s immigration status, so why would reform advocates not offer coverage for illegals?
"the public option will increase premiums for Americans with private health insurance"
OK, I'll grant this one is perhaps a myth. Premiums would certainly increase because reforms mandate adverse selection. Insurers would be forced to provide "insurance" for pre-existing conditions and charge the same premium charged to people without the condition. This, rather than the public option itself, would be the vehicle that would cause private premiums to skyrocket. Small comfort when that when "reform" pushes our insurance prices even higher, a poorly worded survey question led people to incorrectly identify the exact mechanism.
(President Obama deserves a special drubbing for his dishonesty on the issue of pre-existing conditions; one will be forthcoming here.)
"cuts will be made to Medicare in order to cover more Americans"
Medicare is our single greatest financial catastrophe. On its own it is capable of bankrupting the United States. "We" are already promising to cover more people as the baby-boomers age. Medicare will be cut. This is more certain than that the sun will rise tomorrow. (If the sun doesn’t rise, Medicare gets quite a cut!)
What about the "exceptions," the "myths" that only a minority believe? Let’s try two at once:
"private insurance coverage will be eliminated"
"a public insurance option will put private insurance companies out of business"
Both of these are genuine possibilities. The proposals impose adverse selection, minimum levels of coverage, and some offer a - yes, subsidized - government alternative. The effect on the availability of private insurance is simply a matter of the numbers, which have yet to be determined. Obama himself has in the past publicly announced a long run goal of moving to a "single payer" system, so it’s hard for me to understand why we should believe these simply wouldn’t or couldn't occur.
"the government will require the elderly to make decisions about how and when they will die"
Maybe if Mr. Obama himself hadn’t explained that it might be necessary to explain to Grandma why she’s better off with a pain pill instead of a possibly life-saving but expensive surgery we could call this a myth. But he did, and it’s not. If we impose a "single payer" system, it’s certainly a possibility. The "single payer" will be the one who decides what is paid for. It would be more in line with present notions of political correctness and "consensus" building to try to get the elderly to acquiesce in the death decision. Hence this "myth" is credible.
Note that analyzing these "myths" requires some economic theory and evidence, more often than not, and making reasonable inferences about the consequences of proposals. Simply looking at one or another piece of draft legislation won’t suffice. Many of the claims that reform advocates are making rest on extremely doubtful economics, a topic I’ll return to in a coming post. Yet CHPPR claims this is research on "levels of belief in health care reform myths," (myths without quotation marks, please note) according to the banner that scrolls across its homepage. Note also that the details of reform proposals are still under discussion. How can a particular belief, e.g. that abortions might be covered under a finalized program, be a myth when discussions are ongoing?
Here’s the actual CHPPR survey and results. Note "myth" doesn’t appear in it; instead it correctly refers to "controversial assertions," quite a different matter. (It incorrectly refers to "health care reforms currently being proposed by the Whitehouse." The actual proposals are from Congress.) The survey itself seems rather unobjectionable.
Next here’s the CHPPR description of the survey results in which "controversial assertions" suddenly become "myths."
This would have been intellectual and political fraud on the part of the CHPPR, except that Dr. Carroll and company have been careful to include the quotation marks on "myth." So let’s call this what it really is: "intellectual and political fraud."