Friday, May 22, 2009

Krugman on Health Care Duplicity

In his latest NY Times op-ed, Paul Krugman points out that the medical insurance industry is back to their Harry & Louise attack ad ways...
That didn’t take long. Less than two weeks have passed since much of the medical-industrial complex made a big show of working with President Obama on health care reform — and the double-crossing is already well under way. Indeed, it’s now clear that even as they met with the president, pretending to be cooperative, insurers were gearing up to play the same destructive role they did the last time health reform was on the agenda.

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Meanwhile, the insurance industry is busily lobbying Congress to block one crucial element of health care reform, the public option — that is, offering Americans the right to buy insurance directly from the government as well as from private insurance companies. And at least some insurers are gearing up for a major smear campaign.

On Monday, just a week after the White House photo-op, The Washington Post reported that Blue Cross Blue Shield of North Carolina was preparing to run a series of ads attacking the public option. The planning for this ad campaign must have begun quite some time ago.

The Post has the storyboards for the ads, and they read just like the infamous Harry and Louise ads that helped kill health care reform in 1993. Troubled Americans are shown being denied their choice of doctor, or forced to wait months for appointments, by faceless government bureaucrats. It’s a scary image that might make some sense if private health insurance — which these days comes primarily via HMOs — offered all of us free choice of doctors, with no wait for medical procedures. But my health plan isn’t like that. Is yours?

“We can do a lot better than a government-run health care system,” says a voice-over in one of the ads. To which the obvious response is, if that’s true, why don’t you? Why deny Americans the chance to reject government insurance if it’s really that bad?

For none of the reform proposals currently on the table would force people into a government-run insurance plan. At most they would offer Americans the choice of buying into such a plan.

And the goal of the insurers is to deny Americans that choice. They fear that many people would prefer a government plan to dealing with private insurance companies that, in the real world as opposed to the world of their ads, are more bureaucratic than any government agency, routinely deny clients their choice of doctor, and often refuse to pay for care.
The experience in Canada was that all the big interests (insurance, doctors, drug companies) fought bitterly to prevent the government health insurance. They used the same smear & fear campaigns.

The reality was that before government insurance, the poor didn't get the care they needed except in a handful of "charity" cases. The system didn't work. Now everybody gets care. The care is good. Could it be better? Sure, but it would cost more. The government is putting resources into the health care industry in Canada but it has to balance the open-ended demands with the finite fiscal resources.

The only argument I can see for a private medical system is that the rich can afford to pay to create new technologies. But I believe the government-sponsored system could deliver the same innovation. I admit that it doesn't. But this is a problem not a fatal flaw. With proper government direction I believe you can get the same level of innovation.

The big debate in Canada is whether private medical care should be allowed to compete. There is a lot of resistance because people worry that the private companies would cherry pick. They would cater to the rich. Once the rich are well taken care of they would put pressure on the government to "cut expenses" and slowly close the tap that feeds government medical care. By putting everybody in the same boat, the rich have a keen interest in keeping Canada's medical system as good as possible. A two-tier system is like the "separate but equal" doctrine in the US with regard to racial segregation. It was separate, but it wasn't equal. A two-tier system will create two levels of care, but the bottom tier will be starved until it collapses.

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