Health Reform Politics

Mickey Kaus calls Ezra Klein a “concern troll” for his “unsettling thought” that:

[H]ealth-care reform isn’t simply suffering because the public is overly opposed to some of its revenue raisers. It’s suffering because the public is insufficiently supportive of its core. … [snip]

[I]t’s not obvious what health-care reform will do for the average American. I could give you a long answer about delivery system reforms and so forth because it’s my job to know these things. But it would have to be a long answer …. [snip]

Higher taxes aren’t buying them obvious benefits. Instead, they seem to be paying the health-care bills of poorer Americans. … [snip]  [emphases and snips all Kaus’]

First, I’d note that Kaus is incorrectly applying the “concern troll” concept.  Ezra genuinely wants major reform in the health care system and is legitimately worried that it may not come to pass.

Second, it strikes me that Ezra is making the same argument I did, albeit from the other side, in my health care debate’s ecological fallacy post.   People are ultimately concerned about how any prospective reform will impact them personally, not whether the entire health care system will be improved.  A lot of people are correctly coming to the conclusion that the proposed reforms are simply another entitlement program that they’ll have to pay for.   Kaus restates the problem aptly:  “Obama is running into political difficulty because he’s selling the middle class a pain sandwich–more taxes in exchange for more health care cuts.

Kaus has an elegant solution:   “It would have been smarter to sell universal health care as offering Medicare-like security for all. (It’s not too late! And it fits on a bumper sticker.)”   I tend to agree.  That, and some sort of easy portability of insurance between employers, would go a long way to solving the deficiencies in the system that most Americans worry about.

None of it, unfortunately, solves the larger problem:  Health care is too expensive and the costs are rising at an unsustainable rate.

FILED UNDER: Economics and Business, Health, US Politics, , , ,
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College. He's a former Army officer and Desert Storm veteran. Views expressed here are his own. Follow James on Twitter @DrJJoyner.


  1. Herb says:

    About Kaus and the “concern troll” thing.

    Maybe this post by John Cole, where he implies that Kaus is a “contrarian concern troll” — and directly accuses him of “contrarian wankery” — got under Kaus’s skin.

    Kaus reads Balloon Juice? I wonder what he thinks about Tunch…

  2. mpw280 says:

    How about portability of policies between states? Why should states differ in their requirements for health insurance other than to give local insurance companies an edge. If you want to increase coverage, increase competition, the federal government should set a minimum (and realistic) standard for health insurance and everything else that the states want to tack on should be ala carte and priced, then you can take a quote from A and compare it to Z and come up with the best policy for you. Second, if workers get health insurance untaxed, then those who pay their own health insurance should get the same perc, so all pay the tax or none pay the tax, enough pandering to the unions on this one, they can pull their load like the rest of us or we get the same perc they do, end of story. That with tort reform will go a long long way to “fixing” health care in this country. MPW

  3. sam says:

    That with tort reform

    I suppose you mean medical malpractice. Can you supply some figures for the impact of medical malpractice premiums and malpractice suits on the total cost of health care in the United States? Thanks.

  4. steve says:

    Please clarify. Did you just advocate for a single payer system?

    Sam-CBO estimates put the direct costs at 2-3%. The difficult part to determine is the defensive spending part. How often do we order tests and studies just because of fear of a suit. This is a difficult study, as you cannot go anywhere that it does not exist in the US. I do know that when I have met docs from other countries we sometimes chat and the topic of malpractice comes up sometimes. They find it odd that I order tests I know will be negative just because of fear of suit.

    Just as an example, if you show up at most ER’s in other countries with belly pain, they look for the biggies and if there is nothing obvious going on, they will likely send you home with instructions to follow up with your internist or come back if it gets worse. In the US, you will probably get a CAT scan +/- consult or two. That is necessary from the physician POV because if that patient EVER has another complication related to the abdomen, the typical trial attorney goes back and names everyone who ever saw or treated that patient for an abdominal issue. If you do not have that CAT scan, it may be difficult to convince a jury (of people who could not get out of jury duty) that what you saw the patient for 20 years ago had nothing to do with the current problem.


  5. Our Paul says:

    (July 13, 2009 | 09:50 am) two separate issues:

    The cost of medical mal practice insurance to the docs is trivial in the over all per capita health care costs is less than 1% to my recollection. The cost to the individual doc is another matter.

    The impact of medical malpractice suits is diffuse, as it influences health insurance rates and a variety of other related and non related costs centers (see Steve). One thing every doc will tell you. Insurance companies will negotiate with a plaintiff and will only go to trial if the cost benefit ratio (cost of trial vs potential pay out) is sufficient. It is not uncommon that Insurance Companies will settle out of court when they could “win” in court. See here and here, and of course our fountainhead of knowledge, Wikipedia has a section on Medical Mal Practice Insurance.

    Steve (July 13, 2009 | 10:39 am) is correct in his analysis of Emergency Room medicine. It involves not only an over use of tests, but also of a variety of consultants and procedures. You will never overcome the Emergency Room dilemma until you provide adequate care to the poor and non-insured population.

    James, devote yourself the problem you have identified: Health care is too expensive and the costs are rising at an unsustainable rate. You may have to go against the grain of the libertarian/conservative camp which views health care as a commodity from which anybody with smarts can make some money off.

    In the past, I pointed out that one had to identify those who were parasitic and those that were saprophytic within this system. Cut, or limit the parasitic group, and your save money. Arnold Relman, former Editor of the NEJM, has a similar but more (cough, cough) socialistic view, and with less inflammatory rhetoric.

    R. Paul Miller, M.D.

  6. Fletch says:

    Our Paul

    You may have to go against the grain of the libertarian/conservative camp which views health care as a commodity from which anybody with smarts can make some money off.

    I agree. First, all Doctors will now make “minimum wage”. After all, their “smarts” shouldn’t earn them any extra money…

  7. Our Paul says:

    Fletch (July 13, 2009 | 03:27 pm) my lad, in this world you either fish or cut bait. You can stand on the side lines and hurl grenades into the scrum that is grappling with health care, but I am not so sure that heaving grenades solves problems.

    Our host, James Joyner put his finger on two fifths of the problems we face, to wit:

    Health care is too expensive and the costs are rising at an unsustainable rate.

    It is not that hard to figure out. If we pay more per capita than other industrialized countries for health care, if the rate of increase is faster, and health care outcomes are worse, and one out of six Americans do not have health insurance, and 35% are believed to be under insured, the money must be going down some rat hole.

    Now then, if you are tired, and your significant other looks at you and says you have a pasty complexion and are (cough, cough) underperforming, your local doc will probably find out you are anemic. If he / she looks at your stool, and finds some Proglottids, your doc will look at you and say you have a tape worm, and that sucker (pun intended) is bleeding you dry.

    Now then, tape worms are parasites, they contribute nothing to our well being and can cause significant health damage. Our health care system is riddled with tape worms, folks who contribute nothing to the actual practice or delivery of health care, but are sucking money out of the system and putting it into their own pockets.

    Get a grip on yourself mon, we have a problem that impacts our manufacturing and intellectual base. We either solve it, or go down the drain to join other banana republics.

  8. An Interested Party says:

    What!? Kaus is incorrect about something? How shocking…