The Corpus Callosum

It was the second-most-blogged article on the NYT when I got up this
morning; now, it is the first-most-blogged.  It is the article
that reports on a survey that shows 72% support for a government-run
health insurance program.  The program would be similar to
Medicare, but would be available to persons under 65 and not on Social
Security Disability. 

href="http://www.nytimes.com/2009/06/21/health/policy/21poll.html">In
Poll, Wide Support for Government-Run Health

By KEVIN SACK and MARJORIE CONNELLY
Published: June 20, 2009

Americans overwhelmingly support substantial changes to the
health care system and are strongly behind one of the most contentious
proposals Congress is considering, a government-run insurance plan to
compete with private insurers, according to the latest New York
Times/CBS News poll.

The poll found that most Americans would be willing to pay higher taxes
so everyone could have health insurance and that they said the
government could do a better job of holding down health-care costs than
the private sector…

…The national telephone survey, which was conducted from June 12 to
16, found that 72 percent of those questioned supported a
government-administered insurance plan — something like Medicare for
those under 65 — that would compete for customers with private
insurers. Twenty percent said they were opposed…

Complete poll results href="http://documents.nytimes.com/latest-new-york-times-cbs-news-poll-on-health#p=1">here.

This is as close to a mandate as you’ll ever get.  In fact, it is
so “overwhelming” that it would be difficult to consider it to be
controversial.  This makes it rather strange that Congress — and
the media — seem to act as though it is controversial. 

I suppose the controversy come, not from the number of people who
oppose it, but from the amount of money being spent by those who oppose
it.  The “creationism” story shows that it is possible to create
the appearance of controversy when there really isn’t any. 
Likewise with climate change.  All it takes is for there to be a
large amount of money at stake, or a small group of very loud,
opinionated persons.

Oddly, though, there is not a lot of money at stake here, if one looks
only at the total cost.  Given how expensive the current system
is, it is clear that we could have a universal, single payer program
for the same amount of money.  The only difference is where the
money comes from, and whose pockets it ends up in.  But the most
heated arguments seem to be those that focus on the total cost. 
That is completely a red herring. 

The other main argument has to do with control.  Who gets to make
the decisions.  To understand this, it is important to understand
the distinction between two phrases that sometimes are used:

  • Government-run health care
  • Government-run health insurance

They are not the same, although they sometimes are used
interchangeably.  Presumably, any plan would have major decisions
made primarily by patients, in consultation with their healthcare
providers.  I notice that the title of the article, In Poll,
Wide Support for Government-Run Health
, sidesteps this
completely.  It also does not make any sense, taken
literally.  No one is proposing that government run health. 
I’m not even sure what that would mean.

The first paragraph clarifies, with the phrase, “government-run
insurance plan.”  The governemnt would operate the insurance
payment system.  This would, inevitably, exert a strong influence
over health care decisions. 

The thing is, that already is the case.  The difference would be
that you would have goverment agencies exerting the control, instead of
companies with a profit motive. 

Of course, the governement would not be trying to make a profit. 
That does not eliminate finacial considerations, nor should it. 

People are not going to be perfectly comfortable with anything that
leaves control outside of their sphere of influence.  However, I
do not see any way to get around the fact that those who actually have
the money are going to have at least some influence.  If a given
person does not have the cash to just go out and buy whatever health
care they need, then that person will not have complete control. 

Comments

  1. #1 Hyperion
    June 22, 2009

    I’m guessing this means that they’d be applying the Physician Fee Schedule to cover the payments under this plan?

    I suppose that this would still leave the concern that undercompensated primary care physicians would wind up squeezing in more and more patients into smaller and smaller appointment windows to make ends meet, and that these patients would wind up being funnelled towards an increasingly smaller number of offices that are willing to accept the program.

    On the other hand, at least it does open up access to healthcare for people without insuarance, and perhaps by guaranteeing payment for uninsured patients, such a program could revitalize primary care as and make it more attractive as a field.

    One question that I’m surprised you haven’t raised yet is whether Mental Health Parity would be included in such a plan.

  2. #2 cm
    June 22, 2009

    Your distinction between “government-run health care” and “government-run health insurance” is a good start, but I say go one better: get the words “run” and “insurance” out of there!

    Here’s why. First, “run”. Americans are suspicious of the government “running” anything, and really the government would not be running anything, it would be paying for something.

    Second, “insurance”. Insurance is a private entity, a way for insurance companies to make big money by playing odds–gambling, essentially–against the populous, and using every trick possible to enhance those odds or avoid paying out, like disqualification for pre-existing conditions (because then it is not a fair gamble for them!), failure to get the proper pre-approvals, massive clerical errors, etc. We have accepted that this abstruse and barbaric approach to our health–playing a sort of game about it all–is how we do things here in the U.S., and it is called “health insurance”.

    Instead, to be clear about it, what the government is doing is paying for health care. And so, call it “Government-paid health care”.

  3. #3 kevin
    June 22, 2009

    Don’t know if you noticed this, but one thing that puzzled me about The Times-CBS poll report was the breakdown of respondents by voting in the 2008 presidential election.

    48% Obama
    25% McCain
    26% other response

    So, of respondents who indicated a choice between O & McC, it was 66% for Obama and 34% for McCain.

    Actual popular vote percentages:

    56%
    43%

    Seems like Obama voters are overrepresented in the sample.

    And, actual voter turnout was only 56%, but 80% of the sample claims that they voted. Seems like an indication of sample bias.

    I didn’t see anything about correction for sampling bias.

  4. #4 kevin
    June 22, 2009

    oops, clicked post instead of preview. cont’d

    I’m not saying the results would look a lot different, but my guess is that McCain voters would more heavily oppose government run health insurance. Whether or not that would be offset by non-voters (who appear to be underrepresented in the sample) isn’t clear. Couldn’t find anything in the report to answer that question.

  5. #5 Patient
    June 23, 2009

    One of the problems with this poll is that people don’t really understand what Medicare covers and all the problems associated with having it. So they answer the question based on assumptions about a plan that they know nothing about. Medicare is a headache both for doctors and patients. It is hard to find physicians that are willing to take it in places like large urban areas where many of the best doctors “opt out” so they don’t have to be bothered with it. Then there is the problem of long waits for appointments for doctors that DO take it. If you need psychiatric care or psychiatric drugs, forget about it. Very few psychiatrists are willing to even open a case for someone on medicare, and there is no drug coverage for psychiatric drugs like valium.

    There is also the problem of rampant medicare fraud, and there is no indication that an expansion of the program would do anything to lessen that problem; it is much more likely the converse is true.

    All of these things would have led me to answer “no way!” if I had been polled. The government should stay out of the health care business and just provide subsidies for people to buy their own health insurance. The government has already proved what a terrible job they do managing health care, and I don’t think we need to give them any more rope to hang themselves with.