Sunday, April 18, 2004

seditious libel: "If we're going to talk about equal opportunity, we need to mean it. Conservatives like to say that they support opportunity, but when you ask them to provide it, they call you a communist. I don't support public health care because I'm a socialist."

I don't want to take on the whole healthcare argument, because I don't know enough about it to speak intelligently. But, I've had a lot of people challenge me on my self-proclaimed neo-con ideals, without really understanding where I come from, so I want to try and clear that up a bit, so I'll start with this sphere.

Equal opportunity is the key to what I, as a conservative, want for this country. The difference between myself and most liberals is that I don't believe the government can provide opportunity. When you open healthcare to the public system, everyone is assigned an amount of service. Now, granted, the average service may go up. People at the bottom will get closer to what people at the top can afford. The problem is, the total level of service goes down, and becomes restricted by the system the government puts in place.

What you end up with is not equality of opportunity, but equality of treatment. Opportunity implies the ability to progress to the same (higher) level, not the ability to exist at the same level to eternity.

My brother put it well once. Liberals want everyone on the street to have a nice house. And they think that conservatives just want to have a better house than their neighbors. The reality is, we want everyone to have the chance at the best house possible.

I realize that, in the current environment, that isn't possible. But defining what IS possible, doesn't make that better. Government doesn't make problems better, it just spreads them around.

UPDATE [4/19/2004 - 13:12]: First, read the comments posted below, then read this, from my brother James, posted over at diet coke for breakfast:
1) Universal healthcare is not usually criticized on equal opportunity grounds. That's a new one to me... The problem with goverment management of the healthcare system is that it will create more perverse incentives than it already does. Right now, the fee for service system provides an incentive for lots of tests, medicines, and treatments even if they're not particularly necessary because doctor's get paid for what they provide whereas patients only pay their flat copay fee. A government system that ignores economics would only exacerbate this problem. Now as it turns out a better system might be the much reviled HMOs. With the HMO, the doctors are on salary, not a fee for service system. So, they get paid regardless of what treatment they provide. But, as they compete with other HMOs they have an incentive to keep you as healthy as they can for the least amount of cost to you. If someone other HMO does it better, you'd switch. As a result HMOs stress prevention over more costly after-the-fact treatment. Comparison studies in Oregon have shown that HMO patients are just as healthy (if not healthier) than their counterparts in the typical co-pay insurance programs, at a fraction of the cost.

2) Yes the British system is slow... and in medicine that can mean life or death. There are numerous examples of cancer patients, for instance, dying while waiting six months for an appointment. Don't marginalize that important aspect.

3) If the concern is to get people with less income access to healthcare, then purhaps what needs to happen is to decrease the cost of healthcare. That's no small feat however. One way is to institute what some economists call "Managed Choice". Right now the California State Employees system (and I think federal employees system) works this way, and it has gone a long way toward restraining costs. The way it would work is that your employer (or the govt. if you're discussing medicare/caid) would approve a list of 10 or so insurance providors that cover at least a base level of care (ER visits, OB-GYN, etc). The employer pays the cost of the median provider in this list. If the employee wants more, they can chose to pay the difference for one of the more expensive plans. If they don't need all of the services the median provides (eye-glasses for instance) then they can choose one of the less expensive providors and get the difference back in their pay-check. This way you turn employees into educated health-care consumers, and you provide an incentive for insurance companies to restrain costs. In the 1970s when oil crises raised the price of gasoline, Honda and Toyota brought cheap, gas-efficient engines to the market, and beat the pants off of the gas-guzzling Caddies and Lincolns. The consumer won, because the Hondas ended up being, for a long time, better cars for less money. Right now, there are few Honda of health-care, and the cost of the system will continue to spiral upwards until govt regulations allow more to be introduced.

4) The other major reason that healthcare costs are so high is that malpractice insurance is extremely expensive. Until that's brough under control, this whole debate may be academic. If doctor's can't make any money because their insurance costs are higher than what they can get paid for their services, then they'll find other lines of work. If you don't think that's a problem, try having a solid healthcare system with sub-standard doctors.

UPDATE [4/19/2004 - 19:09]: Beth over at seditious libel takes her right to respond to my brother's and my criticism of her healthcare policy.

I think she balked on our concern about the massive failures of the British and other European systems, but otherwise her responses are pretty intelligent, and definitely worth reading. I still disagree with her, of course.

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