The Excluded Middle

Ezra's got a post up about (what else?) health care that, among other things, cites answers to the following poll question:

Which of the following approaches for providing health care in the United States would you prefer: replacing the current health care system with a new government run health care system, or maintaining the current system based mostly on private health insurance?

You see a lot of ill-designed polling questions, but this one actually manages to exclude the major alternative to the status quo, namely a system similar to Medicare, or the health systems of many foreign countries, where the government doesn't run the health care system but the government does run a health insurance plan in which everyone is enrolled. The distinction is semantically subtle but absolutely crucial. In the United States, state and local governments actually run school systems much as the federal government runs the Post Office. In England, similarly, the government runs a National Health Service employing doctors, nurses, etc. running hospitals and other clinics throughout the nation as a government agency.

A very different alternative, however, is to simply have the government run an insurance program that will pay (in full or in part) for (some) medical procedures and services, while still leaving health care providers as private for-profit or non-profit institutions. This is, overwhelmingly, what counts as the "left" position on health care in the United States -- government run insurance not government run health care.

Comments

"This is, overwhelmingly, what counts as the "left" position on health care in the United States -- government run insurance, not government run health care."

It's an important point, and one that isn't made enough.

Posted by Petey | January 15, 2007 11:26 AM

Funny how the "left" position on healthcare seems to be pretty much the same as the "right" position on education.

Posted by Julian Elson | January 15, 2007 11:35 AM

Funny how the "left" position on healthcare seems to be pretty much the same as the "right" position on education.

Sure, if hospitals were allowed to exclude people because they were the wrong color, or religion. Oh, and leave the *really* sick people for the public hospitals.

The ugly reality is that attempts to get private school education paid for by public funds have almost always been racist at their cores. This needs to be acknowledged, especially on MLK day.

Do you want church-run schools that have to answer to government bureaucrats? Isn't that an incursion on religious freedom? Or should the government give the money no-questions-asked? Neither is a good answer.

The best you can hope for is to make educational expenses tax deductible. Unfortunately for you right-wingers, this would encourage people to become educated, and more educated people tend to vote Democratic.

Posted by fasteddie | January 15, 2007 12:55 PM

Funny how the "left" position on healthcare seems to be pretty much the same as the "right" position on education.

Funny how this nation already has a public education system, whereas it does not have a government-run health care system capable of handling even 10% of demand.

Posted by LaFollette Progressive | January 15, 2007 12:56 PM

There's nothing subtle abt the distinction. If it weren't obscured, the 2 by 4 might actually make contact w/ somebody's forehead. There's nothing subtle abt a distinction that is obvious the minute it is stated; and nothing subtle abt the effort to prevent that happening.

Posted by helmling | January 15, 2007 1:53 PM

There's another "middle" option, which is what Arnold Schwarzenegger just proposed for California, to keep existing insurance companies in the loop (with some further regulation, such as outlawing "pre-existing condition" exclusions), but makes government the insurer of last resort for those for whom health insurance is otherwise unavailable or unaffordable.

Posted by wahoofive | January 15, 2007 5:00 PM

Julian Elson makes a good point: the left positions on health care and education are different. It could be that the left is made up of inconsistent hypocrites in the pay of the teachers unions. Or, it could be that health care and education are somehow different.

Posted by lemuel pitkin | January 15, 2007 5:12 PM

'There's another "middle" option, which is what Arnold Schwarzenegger just proposed for California, to keep existing insurance companies in the loop (with some further regulation, such as outlawing "pre-existing condition" exclusions), but makes government the insurer of last resort for those for whom health insurance is otherwise unavailable or unaffordable.'

But this is a stupid, stupid, stupid, stupid option, because it guarantees that the insurance companies make profits off the healthy people, while the taxpayers foot the bill for the unhealthy people. Privatized profits, socialized costs. Stupid, stupid, stupid, stupid.

Posted by Nathanael Nerode | January 15, 2007 6:23 PM

Wait - I actually LIKE the national health care system model. In fact, we in the US have one of the best sub-populations cared for by an inclusive system - the VA health care. It can't cherry-pick patients because anyone service connected has a right to go there, including fairly sick, out-of the health loop patients. Further, it's a huge bureacuracy.

And contrary to the opinions of the early 80s and 90s, it's a fabulous system. Ask any patient about availibility of drugs and they're happy - they pay nothing and get mostly everything they need (in contrast to the complete set of lies by Robert Goldberg: www.washtimes.com/op-ed/20061217-102008-3698r.htm - please email me for a much longer refutation of his article - as a physician taking care of indigent patients, his whole article just pisses me off!). The patients also fairly quick access to clinicians (utilizing a new-open access system) and the facilities have been markedly upgraded.

For the clinicians, the new computer system at the VA - instituted in the late 90s is the best in any hospital - honestly, ask any clinician who has ever worked at a VA: the ease of use, completeness and transportiblity are simply better than any other system out there. Most clinicians usually end up asking themselves - why can't every hospital use this system!

An examination of the VA system shows that a National Health System (not Insurance) can work. Namely, if a government bureacracy as horrible as the pre-90s VA system can make a remarkable 180degree change and become, arguably, the best health care system (by outcome measures) in the country, it might be possible for such an end result to work. Now the problem, as I see it, is the means to get there - there are too many interested parties who would not profit from the transition to such a system. As an example, here in New Orleans, post-Katrina, there are 5 free clinics, and although each tries to work with the other, there are already competing interests resulting in non-compatible computer/record systems, funding, etc. So if health care for the indigent in the health care vacuum of New Orleans post-Katrina cannot meld into a unified system, I'm unclear how a national system with infinitely more complex competing interests can be fixeed.

But if it could transition, I think the final outcome could be palatable to all.

Posted by Adi | January 15, 2007 6:42 PM

um, sorry, i got the wrong Goldberg editorial (reading through the other ones, um, he's a dangerious liar). http://www.washingtontimes.com/op-ed/20070111-084554-5979r.htm

Posted by adi | January 15, 2007 6:47 PM

But this is a stupid, stupid, stupid, stupid option

You may be right about this, Nate. I was just pointing out there are even more choices; it's not all-or-nothing.

Posted by wahoofive | January 15, 2007 8:47 PM

I think the phrase "health care system" here is a sloppy way of saying "health insurance system". That careless mistake is often made, in fact I think we saw it here last week. and the real excluded middle woudl be a mixed system whereby universal coverage is achieved either by the government providing a health plan of last resort, or else providing the funds for people to puerchase their own while regulating the insurance industry to make sure that coverage is available to all.

Re: But this is a stupid, stupid, stupid, stupid option, because it guarantees that the insurance companies make profits

Oh, good grief, why do you care if insurance companies make profits? If we could get universal coverage I wouldn't care if the insurance companies ended up three times richer than God! It would be worth it. And please, please do note that Schwartzeneggar explicitly proposed outlawing the type of cherry picking that you (rightly) object to here since community rating (everyone pays the same for the same coverage) would be mandatory. In what sense would the taypayers be picking up the otabm, except of course in the sense that the taxpayers are also the policy suscribers and those who are healthy would be covering those who are not? I simply cannot believe the idiocy of people in this debate who think it's all about sticking it to insurance companies not getting healthcare to people who need it! There's a perverse sort of puritanism in this post; just as the original Puritans were terribly afraid that someone, somewhere would be having fun, so to these neo-Puritans of the Left are horrified at the thought that someone, somewhere might actually make money.

Posted by Jonf | January 16, 2007 2:33 PM

This is really quite pedantic, but the nation in the NHS is Britain, not England. And since so far as I am aware it costs about half what the US healthcare system does, whilst achieving much the same results, what exactly is so terrible about state-run healthcare?

Posted by Rob | January 16, 2007 6:21 PM

In England, similarly, the government runs a National Health Service employing doctors, nurses, etc. running hospitals and other clinics throughout the nation as a government agency.

But only in England. The unspeakable Welsh, meanwhile, are reduced to treating their squalid illnesses with primitive incantations and herbal remedies. And the Scots simply expose their sick and injured on mountainsides.

Rob: I think the NHS actually does better than the US on some metrics - life expectancy is higher, for example, in the UK. http://ezraklein.typepad.com/blog/health_of_nations/index.html, of course.

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