Health Reform for Dummies: Q & A

Q: Why are you doing this interview?

A: Because of something I read. John Goodman, the conservative economist at the National Center of Policy Analysis, says when it comes to health care, everybody’s IQ automatically drops by one standard deviation, all reason goes out the window, everyone should pay the same premium rather sick or well, young or old, and no one knows what things cost.

According to Goodman, “ We do not as a rule find this attitude in the market for other important goods. For example, most of us think people should pay the market price for the food they eat, the clothes they wear, and the house they live in. We also don’t seem to have a problem with people paying market prices for life insurance or disability insurance.”

Health reform, therefore, is for dummies.

Q: Why is that?

A: Because people think of health care as a religion. This is true on the left, but on the right as well. Health care is a social good. It is not about money but about being good.

Q: So why do the left and right disagree on the public option?

A: Because the left thinks of health care as a government religion, as the good at the top stamping out the bad at the bottom, and the right thinks of health care as the private business of doing well while doing good.

Q: What’s so bad about that?

A: Nothing. It’s simply the Goodist and the Badist philosophies.

Q: Who are Goodists?

A: Goodists believe all conflict stems from avoidable misunderstanding. Goodists think that the world's evils spring from an insatiable quest for profits, and technologies, systems, complexes (as in "medical -industrial") required to maintain profits. Anything that does not spring from the hearts of men, where love abides, is bad.

Goodists confuse wishes for possibilities. Goodists put a higher premium on their own moral intentions than on the efficacy of their actions. Forget the consequences. Goodists champion education and good will and other people’s money as the solution, whatever the problem.

Above all, Goodists like to be seen to be good. Big Government is Good Government when Goodists run it.

Q: But doesn’t that make conservatives “Badists”? After all, conservatives regard health care as a business. That requires margins to carry out one’s mission. No margin, no mission.

A: Exactly. To Goodists, conservatives are Badists because they are realists rather than idealists. Take the conservative attitude towards the concept of a single payer system Conservatives know any open-ended government entitlement leads to unfunded mandates, which even now approach $50 trillion. And not only do conservative detest unfunded mandates, but mandates that restrict the freedom of individuals and employers.

Q: But doesn’t Big Government help bring everybody in line for the common good and the health of the people?

A: It depends on your point of view.

If you are a Badist, you maintain the health system is only responsible for 15% of a nation’s health. The rest is due to culture, social cohesion, sanitary conditions, and economic prosperity.

If you are a Goodist, the health system is solely responsible for a nation’s overall health and longevity. Single payer is good because everybody is equal, even though some are more equal, e.g., politicians and government bureaucrats, than others, the public and health providers.

Goodists maintain when it comes to the national health, money is no object. Social equity is the goal. Let no one, especially those driven by money, rise above the common herd.

Q: But aren’t equity for all and money is no object two of the reasons why Medicare is going broke?

A: Exactly, but witha government religion, money is no object. Power and belief are. Consider the political calculus. In any given population, 90% of voters are well, and 10% are sick. If those who are well perceive health care to be “free,” i.e. involves other people’s money not yours, you will vote for the Goodists. The majority depend on you. The sick are in the minority. The minority are marginal as a voting bloc, and the expense of their care can always be minimized by paying doctors or hospitals less or by disallowing payment for expensive procedures and for those near the end of life. Single payer is wonderful when you are well, not so good when you are very sick or very old.

Q: So “health care” is more important than “sick care.” But isn’t that a paradox? Isn’t medicine supposed to be about caring for the sick?

A: Yes, there’s a paradox. Goodists lose money on the sick. Badists make money out of health and wellness. How? They select the youngest and healthiest populations to cover because that’s where the profit is, and deny or restrict care to those with pre-existing illness. That way the premiums are coming in, but little money is going out. Meanwhile Medicare and Medicaid are taking care of the old and the sick. It’s cherry picking versus bury picking.

Q: But that must create conflict between the Goodists and the Badists? And that must make health reform difficult?

A: Exactly. As Uwe Reinhardt, the always colorful Princeton health economist observed, health reform is difficult because various factions of the profit-gouging health care industry are like Afghan warlords. They make money in their enclaves. When threatened, they retreat to safe havens, and when those havens are threatened, they open fire on the enemies of the status quo.
Q: Thank you for enlightening me.

A: I trust I have raised your health reform IQ.