A Republican on Health Care

Sarah Palin wrote an opinion article in the Wall Street Journal on September 8, 2009. Compared to her Facebook entries and Twitter tweets, it’s a fairly well-reasoned article that tries to get to the substance of the healthcare debate[1]. She advocates what is essentially the Republican position or at least what passes as a policy position.  She starts by quoting none other than Barack Obama and his desire to “talk with one another, and not over one another.”

Ms. Palin and I agree with the President.

She also quotes Ronald Reagan’s 1964 “A Time for Choosing” speech[2]. Reagan states “no one in this country should be denied medical care because of a lack of funds.” Ms. Palin goes on to state “Each of us knows that we have an obligation to care for the old, the young and the sick. We stand strongest when we stand with the weakest among us.”

Ms. Palin and I agree with the former President.

At that point our opinions diverge.

I encourage you to read her article[1] to get the full sense of her argument. In summary, she makes the following key points against the current health care reforms:

  • “A top-down, one-size-fits-all plan” for health care won’t improve the health care system.
  • There is waste and inefficiency in the current Medicare and Medicaid systems, which are government programs, so it’s unlikely that the government can improve these things.
  • Reform will result in increased deficit spending.
  • “Consumer protection” sounds like a good idea, but insurance companies can be unresponsive and unaccountable like the federal government, so consumer protection is just there to deflect attention away from the rest of the proposal
  • “Death panels” are bad.

Let me take these points against reform one by one.

There is nothing inherently wrong with top-down solutions with a broad reach. For example, the military is a top-down government organization with a broad reach. The military is adaptable and so can any legislation written today. Medicare and Medicaid are more of a one-size-fits all approach. These are successful and popular programs, albeit ones with some fiscal problems. The real failure in her assertion is that the current plan isn’t a one-size-fits-all approach at all. The current plan, and I assume she means the public option part of the plan, is optional. If you choose, you can purchase insurance from a private provider. She is arguing against a straw man that doesn’t exist with logic that’s flawed, even if the straw man of one-size-fits-all were true.

President Obama argues that this plan will recover considerable dollars from reducing waste and inefficiency from within a government program. Palin’s assertion is that this won’t work because the government can’t fix problems inherent in government programs. This is pretty absurd on the surface. If law makers see a problem with law, they can resolve it. If stewards of government programs see an issue with the implementation of policy they can act to change it. I am currently working on a Department of Defense contract that does exactly that. It is an initiative to increase collaboration among those in the science and intelligence communities in response to the intelligence failures prior to 9/11 and the changes in the nature of threats since the Cold War. I think her absurd “logic” on this point comes from an unrealistic ideology that is part of Republican thinking. They believe that the government can not solve problems. While I don’t think that government intervention is the solution to all or even most problems, there is a few problems for which only government intervention is required to resolve the issue.

Certainly, the cost of any solution is a real issue. The mathematics of the problem expose a difficult challenge. Health care costs are rising well above inflation. We have an aging demographic. I am not convinced that this reform can be funded on its own revenue stream and on curbing fraud and waste. This is a mathematical problem that exists regardless of whether there is health care reform or not. The question is whether people bear the total brunt of the shifting economics as individuals or whether the government can intervene and ameliorate the problem through regulation and a social safety net. I am a deficit hawk, but I would prefer increased taxes (gasp!) over “pre-existing conditions” and denial of claims in the current system. Fiscal policy is certainly her strongest point, but it’s only valid if she can either offer an effective alternative or admit that the status quo – and more important, its trajectory – is acceptable.

Her argument against “consumer protections” is so lacking in reason, I don’t know how to respond. First, she doesn’t define what “protections” she is talking about, but I assume it is regulation against pre-existing conditions. I think what is really going on here is that she knows that a regulation against pre-existing conditions is universally popular and necessary, but she doesn’t have the intellectual honesty to admit it, so she is simply dismissive of it.

The majority of health care costs occur at end-of-life.  Fiscal issues are a certainly a bipartisan concern. The goal is to reduce expenses in a way that doesn’t impose decisions on the family or medical professionals. One technique is to first ensure that people are making informed decisions about the efficacy of end-of-life treatments.  Second, encourage people to define how their own end-of-life care should progress while they are healthy.  In short, write a living will. To further encourage that, if you want to talk with a medical professional, the consultation should be paid for my Medicare. As for the efficacy of certain end-of-life treatments, there should be good data so that doctors have access to the most effective treatments and their success rates.  You know, that whole “science” thing. They can share that with family in order to make an informed decision on how to proceed with care. The thinking is that if people have a living will to take some emotion out of end-of-life decisions by the family, and the family understands the likelihood of success vs. prolonged discomfort, they will make not only better decisions, but they will make more cost-effective decisions. Guess what? That’s what the current legislation advocates. Guess what else? The medical professionals analyzing the efficacy of certain care are the “death panels.”

So if this Democratic reform is what Palin and her like-minded Republicans are against, what are they for? Well, it’s a lot harder to solve problems than to criticize, so she doesn’t go into any substantive detail on the hard part. She defers to the Cato Institute, a conservative think tank, that feels that government vouchers would be given to Medicare recipients to be spent on private health insurance. Of course, vouchers and tax credits – the Republican mantra to solve all problems – creates a revenue shortfall for the government and thus drives us toward deficit spending.

Republicans are creating concerns that government bureaucrats will make health care decisions, while ignoring the reality that industry bureaucrats are doing exactly that now. I have personal experience with insurance denial of claims. The procedure we, the family, wanted was deemed “experimental” although it had been used in common practice for over 15 years. Fortunately it was not a life or death issue and it wasn’t particularly expensive but the insurance companies have the power to deny coverage capriciously. Personally, I will take the bureaucrat without the financial incentive over the one whose motivations are for profit-taking.

Before I close, I have to address the big elephant in the room.  Ronald Reagan asserted a shared ideal that people should not be denied medical care, but 45 years after his speech, that’s exactly what we have now. It is time for real health care reform of the type proposed by the current administration.


[1] http://tinyurl.com/lzwnz7

[2] http://www.nationalcenter.org/ReaganChoosing1964.html


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