Reframing the debate.

[alexandraerin]

Here's the question we should be asking all public figures who are against a public option or other form of national health insurance:

"[Senator/Congressman/Pundit], how long have you believed that France is better than America?"

It's fairly easy to point to the failings in the Canadian health care system... a system, incidentally, that neither President Obama nor the Democrats in the legislature are looking to as an example... but France, which has a system closely resembling the much-denigrated "public option", has the top-rated healthcare system in the world.

France can manage to provide quality health care to their entire population and we can't? And it would be too expensive for us to match the feat, when they do it while spending less money per person than we do?

I'm sorry, I don't buy it.

I'm sure the reason that the supporters of the public option have been pointing to France is... well... as I've said before, liberals have a real problem with sitting back and allowing their opponents to frame debates. "Speak softly and carry a big stick" worked fine for Teddy Roosevelt, but it wouldn't have worked so well for his cousin Frank, who had to speak loudly and often just to make himself heard. If we pointed to France and said "We want our country to be more like that.", the right would jump on it in an instant... I mean, we're talking about people whose response to half of the things our president does is to say "arugula" like they've made some great and telling point about policy.

But with France using the public option and not just making it work but making it work so well that they have the best medical care in the world, consider the implication being made any time somebody says that the public option wouldn't work in America or that it would result in worse care for most people:

America is less capable than France.

In my previous post on the subject, I framed things in terms of goodness vs. greatness. Well, let's talk about greatness. As I said, we put a man on the moon. Is there any reason we couldn't take the number one spot away from France if we wanted to?

A lot of our political representatives and media figures seem to think so. Let's put them on the spot and ask them why that is.

Comments

[chaosherder.livejournal.com]

3. Adverse Selection

http://en.wikipedia.org/wiki/Adverse_selection

Okay, from politics to theory. Adverse Selection is the primary cause of market failure in insurance markets and why I support gov't intervention in such. In a nutshell, adverse selection happens because insurance firms know less about consumers than the consumers. Couple that with the people most wanting to consume insurance are those most likely to need it, and you end up with a cycle of inflating costs.

Because of the cost structure of HC and the distribution of risk insurance demand ends up with a higher mean than median, so to speak. because firms try to maximize profit (basic assumption, profit v non-profit HC is another debate for another time) their actuarial models tell them to increase prices. however, basic market models tell us that as price goes up, quantity demanded goes down. The problem is that the drop in demand quantity is not from those driving up costs in the first place; healthy people are much more likely to drop insurance due to cost as health care is less valuable to them. So healthy consumers leave the market, and costs to insurance firms go up, leading them to futrther adjust prices up, leading to more force out, etc. of the 45 million americans that lack health coverage, over 2/3rds simply choose not to buy it. this is the root cause.

A problem with both american and french health care systems is that they do nothing to address adverse selection, and in fact make it worse. speaking specifically of the american system, tax structures give incentive to the purchase of insurance through employers. this causes the problem of healthy coworkers subsidizing unhealthy coworkers. and then as the healthy coworkers drop out (which is more valuable, the $600/month insurance through work or the $500 extra after taxes that can purchase the same coverage for $350?), again, costs to the insurer go up so costs to the employer go up so costs to everyone go up. by clumping people together we make adverse conditioning worse...okay, getting tired, lot more to cover...less rant/more concise needs to start.

and yes, the insurance companies, specifically the executives, make too much money. part of this is due to americans being conservative in nature and over consuming insurance. but the bigger part is america's corporate culture and the legalized theft it allows.

4. Corporate Culture.

Corporations are not evil. they are risk spreading devices. yes, santa clara v southern pacific railroad and other corporate personhood issues are troubling, but the root problem isn't corporations but the regulatory clime.

Not going to go as deep into this but basically the top of america's corporate ladder is a rich boys club where everyone votes to give everyone else huge pay raises (they all sit on the exec boards of each others corporations). combine this with regulatory capture and you get legalized theft, both from consumers and shareholders. what is currently happening in america is not how corporations are supposed to work. they have gained control of such bodies as the SEC and as such use regulation to force out competitors rather than to ensure market function. so again, we have market failure.

5. Regulatory capture.

http://en.wikipedia.org/wiki/Regulatory_capture

getting really lazy, wiki can answer this one. for more info look also into game theory and public choice theory. basically the market fails because when everyone acts in their own interest those who have the most interest in a regulatory agency end up, essentially, buying it. and everyone who does not have interest lets it happen because it is not in their best interest to spend billions of dollars fighting it.


There are probably other problems i'm forgetting...


okay, way past my bedtime. if you want to look at a functioning health care system, look at singapore and into governmental reinsurance. more to say on this but that would require a third page...sorry if i got ranting. there's also more to be said on education reform, tort reform, etc, but the big problems are food reform and control of adverse selection. I'm probably not going to post again as i prefer reading and lurking (love your work btw AE) so, yeah.