Along the lines of physician heal thyself, would you consider getting your own meds adjusted?

Such language! What is with this "a******s", anyway? Oh, you're a nasty m***erf***er, all right.

And way to take responsibilty for the health care debacle. It was ALL somebody else's fault? Hillary and Bill were blameless? No mistakes by the Task Force? Well then, good job and hard luck, you masterflamer, you.

Aloha,

1) Tom Maguire is a jackass.
2) When I was in Washington interning with a senior Indiana senator last year, they made me do lots of research on the adoption of IT by healthcare industries. The best article I found was a contrarian view arguing that since the widespread use of IT would radically speed up transactions, the health insurance companies would never use it, since it would just take away the interest they earned on the float. That was one of the first steps toward my not calling myself conservative anymore -- guess that FDR was right when he said that gov't can stand up for the Forgotten Man.

Re:

>>It was ALL somebody else's fault? Hillary and Bill were blameless?<<

Oh, I have very harsh things to say about how they handled the reform effort. Here, for example...

Brad DeLong

Uh, Professor? I think Paul was unkind to me. I'm about to burst into tears, but maybe if you admonish him and show him your new policy, I'll feel better. No need to delete him, though. And in the case of good manners, I don't think that "truth is a good defense".

As to your view on the task force, of course I remember your view. We went over this a month ago. I just worried that, with all your "thank-yous", maybe you had forgotten your view, or changed it.

Aloha,

The flaw in Mr. Maguire's reasoning is this: the Clintons were, on this occasion, bad politicians and bad managers, and their failings helped to squander an opportunity to fix America's broken health care system. But the Clintons' failings wer in no way comperable, in terms of moral culpability, to thos of people like Gingrich, Dole, and Kristol, who were simply satisfied that the system remain broken and that their allies and funders continued to make tons of money.

I'm curious what you think about a single-payer system. I know many of the details about this type of system, so I see the errors and ignorance used in the attacks against it by right wingers.

I've looked for a problem with this type of system, but the only type of argument I've seen against it that isn't obviously wrong are the ones made by followers of Ayn Rand arguing against redistribution philosophically.

I guess my question is, since you're a smart economist who has worked on this type of thing, is there any problem with single payer besides the politics of passing it? I'm really curious to know if I'm wrong about this issue.

I think professor DeLong forgot to add "Thank you, Ted Kennedy". Wasn't it Senator Kennedy who pushed through the legislation in the seventies that forced HMO's on everyone?

>>Wasn't it Senator Kennedy who pushed through the legislation in the seventies that forced HMO's on everyone?<<

??????

Maybe in some parallel universe, but not in this one.

Brad DeLong

>>is there any problem with single payer besides the politics of passing it?<<

The problems you have with every government operation: bureaucratization and underfunding. I remember a time in the 1960s when Britain's National Health Service was simply not treating elderly people with diabetes...

But yes, single payer has lots of advantages too. However, I don't have an informed view: I need to borrow one from David Cutler.

Brad DeLong

The HMO Act of 1973 required employers (with 25 or more employees) to offer HMOs to workers. Senator Kennedy sponsored this legislation. Perhaps this doesn't qualify as force in your book, but it did happen in this universe.

(Give people a choice) != (Force)

Brad DeLong

Companies could have chosen to carry HMOs prior to the law passing. Many chose not to do so. Forcing companies to add HMOs didn't increase choice, it decreased it.

When Congress passed must-carry rules for cable TV companies, I guess that was giving people a choice as well?

I am not aware of a time in the 1960s when the NHS stopped treating elderly diabetics, and am pretty sure I would have grown up with fewer grandparents if it had. Might this be an urban myth?

Seems pretty clear to me that the UK health service actually has very few problems and that "underfunding" is somewhat problematic given that we cannot take the USA's healthcare costs/GDP ratio as a norm; the NHS was designed to be a second-rate healthcare system delivered for the price of a third-rate one, and it does pretty well in that role.

Brad,
If you are going to defend Hillary's health care plan, then you are the first economist to do so. I have talked to other economists who worked in the Administration at the time who were appalled by it and were upset that economists were ignored.

I have many beefs with the plan. However, the most important is the accounting. The plan was going to save some huge proportion of Medicare spending by "unspecified efficiencies." I remember calculating that if they cut physicians' salaries to the level in the UK, drove drug company profits to zero, and did everything else liberals say will reduce health care costs, they still could not possibly have hit their numbers.

And you want to resurrect THAT?

The diabetes story may well be an urban legend: let me try to find out.

Oh, if only I had a brain in which every idea and factoid came tagged with where, when, and from whom I heard it!

Brad DeLong

Oh, you can google for "Ukockis health association american physicians" if you want to know what we in the Treasury thought of the Magaziner plan.

Even in the late spring of 1994, however, Lloyd Bentsen was confident that we could get a good, productive, system-improving bill out of the Congress that year. What we hadn't reckoned with was that the Republican Congressional leadership would buy Bill Kristol's argument that the better the substance of the policy proposal, the more important it was for Republicans to block everything--for the Democrats would win powerful political benefits from a bill that actually fixed many of the problems of America's health care system.

And meanwhile, Ms. Debbie Oliphant continues to beg someone, somewhere to issue her a HIPA certificate...

Brad DeLong

I wanted to contribute the information that there is practical help for for individuals who encounter problems with COBRA and HIPAA. The Pension and Welfare Benefits Administration of US Department of Labor enforces the requirements that group health plans supply HIPAA certificates and offer COBRA coverage. PWBA has 10 regional offices and its customer service unit can be reached at toll-free number 866/275-7922; the PWBA website is at www.dol.gov/pwba. In the case of the woman who was having trouble getting a HIPAA certificate, Blue Shield may be violating the law by refusing to issue the certificate to the woman until they receive notice from the sponsoring employer that her COBRA coverage is canceled. HIPAA certificates must be made available to participants on request, even while the participant is still covered. To resolve this type of problem, PWBA would call the sponsoring employer and the insurance carrier, advise them that a group health plan cannot refuse a certificate to a participant who requests it, and obtain the certificate for the woman.

Ms. Gottschall's thoughtful post certainly clarifies for me why we wouldn't want to implement one of those socialistic single payer plans. I'd hate to see sick Americans have to deal with a bloated self-serving bureaucracy in order to obtain health care. Thank goodness we've avoided that horror.

The NHS isn't single payer, it's socialized medicine, which is different.

Besides that, Canada's single payer system is a lot more efficient than America's system, with a lot less bureaucracy and waste. It is somewhat underfunded, but people who need care urgently always get it urgently. I guess a good article to read about the myths about Canada's system is here: http://www.washingtonmonthly.com/features/2000/0007.marmorsul.html

As for underfunding, Canada's system is slightly underfunded largely because wealthy people can go to America for health care. There would not be much of an underfunding problem in Canada without America, because Canada forbids private insurance for things that are covered publicly, and it forbids doctors that accept the public insurance from taking private payments from anyone who has the public insurance (all Canadians).

Britain's underfunding problem is a bit different. Unlike Canada, the government owns most hospitals and pays doctors by capitation similar to the way American HMOs do. But private health insurance is allowed (it even used to be encouraged under past Conservative governments), and doctors are allowed to take payments on top of what the NHS pays, so that people who pay can be pushed to the top of waiting lists. So, because the wealthy don't really need the NHS, there hasn't been as big as an incentive to fund it.

I don't think America wouldn't have a problem with underfunding if it adopted a Canadian style system where the wealthy had no other easy choice. As for bureaucracy, everything I've seen on this topic indicates that private health insurance is a lot less efficient and a lot more bureaucratic than a Canadian style system. Canada's insurers just spend about 1% on overhead, compared to HMOs which can take 30%. I've read that even the most efficient American health insurer spends 9% on overhead. Market forces actually increase overhead as insurers try to find ways to avoid enrolling the sick and avoid paying for the expenses of the enrolled. Besides that, dividing the health insurance pool into hundreds of funds makes things a lot more complicated for doctors and hospitals.

As for digby, there is virtually no health care bureaucracy in Canada. In America, bureaucracy is partially created by government, but it's mostly created by the market force of competition between private health insurers. The private health insurers are the bloated self-serving bureaucracy.

Arrgh, I didn't mean to turn this into a ramble. Sorry.

And if anyone thinks I'm the type of lefty who would support any socialistic government program, I'm not. I was very skeptical about single payer, as I am about most government schemes, but then I read a lot about it. I think welfare reform was probably a good thing (does that put me to the right of Brad?), am leaning towards privatization of Amtrak being a good idea, support free trade, want to abolish agriculture subsidies, etc. God, I'm rambling again. I better stop now and post this.

>>As for digby, there is virtually no health care bureaucracy in Canada. In America, bureaucracy is partially created by government, but it's mostly created by the market force of competition between private health insurers. The private health insurers are the bloated self-serving bureaucracy.>>

I know. I was joking. The hoops that the woman was being told to go through in the previous post rival anything the old Soviet Union cooked up for pure bureaucratic inefficiency. Obviously, my writing skills leave something to be desired if I didn't make that clear.

>>my writing skills leave something to be desired if I didn't make that clear.<<

It was clear to me, but it is amazing how much of what would be obvious in speech, or in extended prose, is lost in short internet snips.

I've actually taken to enclosing my sarcastic remarks inside ... tags to try to make things more clear.

Brad DeLong

Maybe it's my fault. When I have time to do things on the Internet I'm usually very tired, as I was when I wrote that. If it had been earlier maybe I would have noticed it. Also, what you wrote is similar to things I've seen written about single payer by right wingers. I had no way of knowing you weren't one of them.