The first thing I mentioned is that I have a personal interest in the bill's provision that patients cannot be denied coverage for pre-existing conditions, as I have already gone through the experience of being denied coverage due to a mild case of high blood pressure that requires me to take some low dosage pills. Luckily, I got a new job later that covered me, and I can now extend the same plan under COBRA if I switch jobs. But it was a tense few months for me.
Later, I wrote:
Me:
Libertarianism has always struck me as a severe case of having only a hammer in your toolbox and perpetually seeking nails. Is the economy doing well? Then it's time to lock in those gains by eliminating regulations. Is the economy doing poorly? There are too many regulations. Is the economy still doing poorly after regulations have been gutted or deliberately unenforced in a particular area? The measures didn't go far enough; the solution is to roll back more of them. When I say that I am results based, what I mean is that you should be willing to actually compare economic conditions during different times or across different countries that have more or less regulation in these areas.
Libertarian "experiments" don't appear to confirm their hypotheses, because countries with varying degrees of regulation don't appear to reflect the claim that an unencumbered economy is a healthy economy. Let me demonstrate with a little on-the-spot research. The United States ranks 38th in a list of countries by life expectancy. Quick spot check. Among the top three countries:
- Japan provides healthcare services, including screening examinations for particular diseases at no direct cost to the patient, prenatal care, and infectious disease control, are provided by national and local governments.
- Hong Kong has a mixed health care system, with public hospitals being managed by their Department of Health.
- Iceland has universal health care.
All three of these countries I just looked up have stronger government involvement in health care than the bill that just passed. By contrast, let's take a look at the bottom three.
- In Swaziland, public expenditure on health amounts to 4% of the nation's GDP. This is less than the United States has now (a little over 6%).
- In Mozambique, public expenditure on health is about 2.7% of the GDP.
- In Zambia, public expenditure on health is about 3.4% of the GDP.
This is the kind of elementary research that I mean when I say that I would prefer evaluation to be driven by outcomes and evidence. Now, granted, health care isn't the only factor in life expectancy. However, there is a clear correlation that seems to belie the assumption that "more public involvement => worse results." Obviously I haven't done an exhaustive survey of all 195 countries on the list. But I'm willing to bet that a completed graph would retain the overall pattern that countries which spend more public dollars on health tend towards higher life expectancies, and vice versa.
Lib:
Of course people are healthier when there is more access to healthcare. The question is, who is better at providing the health care. Governments make the claim to cover everybody. But that's all it is, is a claim. We hear a lot about private insurance companies rejecting individual people's claims. But that's nothing to the number of people rejected by government plans. Just look at Massachusetts.
Me:
I think I've covered this question pretty well by my back-of-the-envelope survey of other countries. But all right -- I took you up on your request and looked. First thing I found was that Massachusetts has the lowest rate of uninsured residents in the country, at 5.5%. It was 8.7% in 2006, before the bill was enacted, so it has dropped significantly. The highest uninsured rate? That would be Texas, illustrious home of no state tax, clocking in at 26.9%.
I also looked for something to corroborate your implication that more claims are denied in Massachusetts than in most other states, but have so far come up empty handed. If you have evidence that Mass's system has enough negatives to offset the very excellent coverage rate, I'm sure you'll let me know. In the meantime, I'll continue my previous theme and take a look at life expectancy by state.
Huh... what do you know? Liberal Massachusetts with their public health program is fifth highest on the list. Texas, with the highest number of uninsured, comes in at 34.
Now, you might fairly regard this as a little bit of sleight of hand, since Mass only enacted their health plan a few years ago, and the results on life expectancy could hardly be expected to be measured thoroughly by now. However, Mass has always been demonized by economic conservatives as being an example of rampant "socialist" liberalism at its worst. So I'm content to have past results of this horror be reflected by the life expectancy now.
In a followup letter, this exchange occurred:
Lib:
The best analysis I've seen of [a nation's economic strength] is the Economic Freedom Index. The way I found out about this web site was a few years back when it made headlines (at least in Europe) that the US was no longer in the top 10...
http://www.heritage.org/index/Ranking.aspx
Me:
That's interesting, but it is begging the question. The Heritage Foundation is a well known conservative economics think tank. Any standard they use for measuring "Economic Freedom" is bound to involve qualities which are in line with the goals of the Heritage Foundation. Such a concept is inherently subjective, and assumes that the things that you want out of a government (i.e., lack of public funding for health care) are for the best. You can probably see why I'm hesitant to accept this as a neutral measure of how good those countries are.
Lib:
[I don't] value life expectancy if it interferes with quality of life. I had the privilege of sitting in on a health panel at Renaissance Weekend last year. There were many doctors and hospital administrators from Massachusetts. They were talking about a patient they refer to as the "Six Million Dollar Man" because there is no limit to what they are obligated to pay to keep this particular patient alive. To continue end of life treatment to this extreme will break the budget if everyone recieved such care.
Me:
You are, again, begging the question. I chose life expectancy because it is a relatively easy to obtain quantification of the overall health of the nation, one which is objective enough that it can't be easily fudged. If all else is equal, I assume you and I would agree that we'd rather live a longer life than a shorter one. (Or as Dave Barry once eloquently put it: "Son, it is better to be rich and healthy than poor and sick.")
But you've introduced a red herring, in saying "if it interferes with quality of life." Without providing any supporting data to show that quality of life suffers a lot from living in Japan, Hong Kong, or Iceland, this has nothing to do with what I said. If you'd like to pick another neutral measurement of quality of life, make a suggestion. But I'm not taking "The Heritage Foundation likes them" as an answer.
Here's an example of another standard you might pick for "quality of life." There is an organization that takes a snapshot of self-reported happiness by country.
http://www.nationmaster.com/graph/lif_hap_net-lifestyle- happiness-net DEFINITION: This statistic is compiled from responses to the survey question: "Taking all things together, would you say you are: very happy, quite happy, not very happy, or not at all happy?". The "Happiness (net)" statistic was obtained via the following formula: the percentage of people who rated themselves as either "quite happy" or "very happy" minus the percentage of people who rated themselves as either "not very happy" or "not at all happy".
In a similar vein to my previous message, I note that the top three countries -- Iceland, Sweden, and Denmark, all have universal health care.
