The government has already proven itself

A small sample of what will happen once we hand over the healthcare reins to the government:

Perhaps we could give the government a trial run as a healthcare insurer by letting it handle a smaller prototype to see how it would do. Oh, wait. Medicare reimbursement is going to decline 10 percent (did any of my expenses decline 10 percent last year?); our local government-run city hospital is millions of dollars in debt and on the verge of bankruptcy; and our state’s Medicaid program for children is crying out for funding.
Has the government demonstrated itself worthy of any additional responsibilities?

Comments

Matthew
Unfortunately, documenting complete and umitigted failures by all levels of government at in virtually every arena has never made a bit of difference to those who have it in their heads that big government is the answer. It’s a lot like trying to reason with someone whose beliefs are religious and faith based; you can talk all you want and explain things down to the last detail, but in the end, they won’t care a bit.
Evan
Matthew:
If the US government demonstrates complete and unmitigated failure at virtually every arena — why don’t you speak German? How do you get your mail? Why does your plane not crash? Why does the freeway system work?
Seriously, if that’s the truth, why do you live in the US if you do?
Rich, MD
For all of the examples provided by Evan, there is private, free-market competition with the government.
There is private mail delivery (UPS, Fedex, smaller messenger services, email, fax), private roads, and privately owned airlines with a vested interest in propoer functioning of the air control system.
I don’t know what German or language has to do with government success, it is no small proportion of the US population that does NOT speak English, and most municipalities, state, and federal agencies provide documents in as many as 22 languages or more.
Where the government fails is where there is no free market competition. Medicare, for example, because subscribers cannot choose to spend their Medicare dollars elsewhere.
Evan
Rich,
German is the language of the National Socialist party of Germany. They wanted to rule the world and eliminate the US, the UK and the USSR. The US, the UK and the USSR stopped them. If you think there was “free market competition” that forced them to do a better job I’m curious how that worked.
Hope that clears up your confusion.
Also I’d like to know where this private interstate freeway system or private air traffic control system are in place. Please let me know.
Anonymous
“I don’t know what German or language has to do with government success”
You are a disgrace for every soldier who has ever fought for your rights and for the fact you are not speaking German today!
Rich, MD
I meant no disrespect to soldiers or the military. Frankly, I did not make the connection that Evan was proposing with regards to Government success and WWII.
I am not sure, though, that military success is any predictor of the ability to deliver healthcare.
Evan
It’s actually a pretty cogent point and please forgive me if I run on a bit here.
The purpose of the government is to protect and defend the borders, allow freedom to trade, and protect the general welfare of its citizens.
If you think the military should be totally privatized, then you fail to understand the lessons of history. The fact is that the only countries that have succeeded over the long term have had militaries that are made of citizen-soldiers. The reason is that once militaries are outsourced, they become the seat of power. History abounds with examples but the Mameluks, the Visigoths and Xerxes’ Greek army are a few.
So there is general agreement among most people (even libertarians) that one of the things that cannot be privatized is the military. It is a core function that only the government can do. Yet — it is the one thing that allows the survival of the nation-state against hostile invasion. It is the sine qua non of a nation.
Throughout history the single greatest source of death of soldiers has been medical illness. So the military in the US has always had active duty medical care, and the medical casualty rates for US forces are at the historical low end versus many other forces’ historical averages.
If you genuinely believe, as Matthew said in his first post, and as Rich seconded, that it’s impossible for the government to accomplish anything, you are saying that the republic can’t survive, since the survival of the republic demands some ability for the government to accomplish some things.
So I think that argument simply falls to tissue when examined.
However, if you are really making a slightly different argument: one that says that the current government is making lots of bad decisions but if better, more knowledgeable people could make better decisions that would ameliorate the situation to some degree, then I think you are admitting there is the possibility that the government need not fail at every task and that the problem is a current general level of incompetence that could in theory if not necessarily in practice be fixed.
So I guess my question is: are you stating a general and total theory of governmental incompetence that is a systemic source of all government programs? Or are you stating a localized complaint with a specific set of current governmental situations that could in theory be ameliorated?
If you believe the first answer is yes, I really don’t see why you continue to live and work in such a dangerous place to be. If you believe the second, then the proper response is to work to change the specific problems you have with specific governmental policies and decisions that should be reversed because they are bad.
The first position makes a much more convenient scapegoat, but I think it’s really quite false.
Rich, MD
I actually never made the point that the government is incapable of accomplishing anything.
I make the point that, where a private sector is capable of providing a service, it has a greater potential to succeed and innovate than the government. The government has shown, fairly consistently, that it cannot compete with the private sector.
Where the private sector has no role (e.g. the military, defense) the argument is moot, which is why I failed to make the connection regarding German in your first response.
I fall closer to your second scenario, with the caveat that the best way the government could improve the situation in many cases would be to regulate less, and meddle less, rather than by creating new programs or increasing the size of existing programs with their associated costs, beureaucracies, and agencies with no stake in success.
The fallacy of your argument, IMHO, is the assumption that the only viable solution to problems such as healthcare MUST come from the government.
Evan
Rich,
You never made the point, but Matthew did in the first post on this thread and that is what I was clearly responding to.
But to your point! So you think the private sector has a “greater potential to succeed and innovate than the government”.
I don’t.
What we need is to do an experiment where we take federal dollars and assign the per-patient amount to a private company and see if they can deliver healthcare either cheaper at the same quality level or better than the government does at the same price.
Guess what?
We already did it. It’s called Medicare part C. The healthcare corporations with the help of congress passed a law allowing them to enroll patients and see if they could give care cheaper than the government could — and they failed. They failed miserably and the program was rescued by the only method that is possible — paying them more (12% more).
So how do you explain this Rich?
Rich, MD
The Medicare Part C (Medicare Advantage) argument fails because it is not a true comparison.
Medicare advantage plans generally include benefits that Medicare does not, and some also charge a premium to the patient in addition to the medicare premium. So, in fact, it is a program compeltely distinguishable from medicare. You comparison would only work if the services offered were the same, or if there was no patient contribution.
For example, comparing the BCBS basic Medicare advantage plan in my area:
1. Hospital deductible is lower, and limited for Medicare Advantage,
2. Skilled nursing care costs less per day after the first 20 days, and does not require a hospitalization (Medicare only pays after hospitalization).
3. Medication related to hospice care are covered 100% (not so for Medicare).
4. Emergency care is covered worldwide (not so for Medicare)
5. Urgent care is covered Worldwide (not so for medicare)
6. No deductible/co-pay for mammograms or pap-smears (20% for Medicare)
7. Hearing screening exams and hearing aids are covered (not so for medicare, which does not pay for hearing aids)
Anonymous
With all due respect to the bravery of our soldiers, the success of the Allies in WW-2 did in fact have quite a lot to do with the ability of American industry to ramp up production to levels the Germans could not match.
Evan
Rich — what the benefit plan is now is irrelevant. The private sector tried to offer profitable care for the same amount of money that the government did. If the private sector were as superior as everyone says the difference would have been greater than the cost of 20% of mammogram copays could have been. Are you really arguing that hospice medications, 100% worldwide ER coverage and the other items you mentioned require a cost plus 12%?
There should be at least some measurable improvement in care or decrease in cost in the privately managed plans if the government is as inept as Matthew and you seem to suggest. Yet as far as I am aware (please let me know if I’m wrong), there is not a shred of data to support that contention, and much (12% greater payment) to suggest it’s not true.
Anonymous
Where is the shred of data that a government-run universal healthcare plan would do any better than the semi-universal, government-run healthcare plan we already have? (It is universal in that there is no realistic alternative – Medicare Ddvantage included – for Medicare benficiaries – the universe is just a smaller one). That is, after all, the whole point of this post.
Evan
Anon 7:16,
The shred of evidence is the universal health care systems of all the other western democracies. They all cost less and they all get better results, not to mention the shred of evidence that Part C Medicare did not benefit patients at all but did benefit the health care companies.
Anonymous
If people would just learn to take care of themselves in the US our system would work MUCH better. Our system excels at taking care of sick people, whereas the European system excels at taking care of healthy people.
I personally would rather have a healthcare system that takes care of sick people well because I don’t need a doctor telling me to exercise and eat right in order to stay healthy. I already know how to stay healthy!

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