Collectivist-Conservative Health Reform Standoff

I pass with relief from the tossing sea of Cause and Theory to the firm ground of Result and Fact.

Winston Churchill (1874-1965)

November 1, 2011 - In his October 31 Health Care Blog, “The Collectivist Mind,” John Goodman, economist, conservative, founder of the National Center for Policy Analysis and Father of Health Savings Accounts, explains the Liberal-Conservative health reform standoff – and why never the twain shall meet.

According to Goodman, to the liberal, market results, even when superior to government results, never measure up.

Goodman says, to colectists, it’s the political belief, and the process, not results, that count. Markets are evil. Only the collective, not individuals, are equipped to decide about care. That is that. Period. End of discussion. Is he right - or just overwrought?

Here is his blog.

Most people in health policy are collectivists. This is a predilection they share with many on the political left. They value collective action over individual action. They trust collective action more than they trust individual action. And they hold collective action to a lower standard of ethics. If a public official and a private citizen commit the exact same wrongful act, the private citizen will be judged much more harshly.

Consider this revelation in the news the other day:

• Arizona…plans to limit adult Medicaid recipients to 25 days of hospital coverage a year, starting as soon as the end of October.

• Hawaii plans to cut Medicaid coverage to 10 days a year in April.

• Other states have already limited hospital stays under Medicaid: the limit is 45 days in Florida, 30 in Mississippi, 24 in Arkansas and 16 in Alabama.

What if you are in Hawaii and you need 15 days of hospital care instead of 10? Apparently you must pay out of your own pocket or forgo needed care.
What was the reaction to this news in the left wing press? Virtual silence. It was ignored by the editorial page of The New York Times, which ordinarily has an opinion on almost everything. Ditto for the Washington Post and the New Republic. Can you imagine the outrage that would have ensued if BlueCross had done the same thing?

Two provisions in the health reform act (ObamaCare) reflect the same double standard. First, private insurers will not be allowed to have any annual or lifetime caps whatsoever on the amount they will spend on an enrollee under the new law. At the same time, half of the newly insured under the act will be enrolled in Medicaid — where the limits will apparently border on the unconscionable!

The inability to judge private and public programs by the same set of ethical norms has long affected left-of-center thinking.

If a private insurance company denies a breast cancer patient a bone marrow transplant, that’s considered a moral outrage — even if the procedure is experimental and is later shown not to work anyway. If the Arizona Medicaid program denies people organ transplants that do work and save lives, that is considered an unfortunate budget issue.

If 25,000 British cancer patients die every year because the National Health Service won’t buy the drugs that would have prolonged their lives and they cannot afford to pay for those drugs out of their own pockets, that is considered, again, an unfortunate budget problem. But if even one uninsured American dies prematurely because he or she cannot afford those very same drugs, that is ethically unacceptable.

Many people in health policy viscerally dislike the idea of private Medicare Advantage plans. They instead would like to see everyone in conventional Medicare — a public plan. You would be amazed at how many otherwise knowledgeable people are completely unaware of the fact that Medicare is not actually run by the federal government. It’s run by private contractors, including such private insurers as Cigna and BlueCross.

The view that public Medicare is good and private Medicare is bad really amounts to saying that when BlueCross is called “Medicare” it is good and altruistic, but when the same company is called “private insurer” it is bad and selfish. It makes no sense, but that’s the collectivist mind set.
If I can indulge in a bit of psychoanalysis, I believe most people on the left care much more about process than they care about results.

Take the Canadian health care system. I’ve engaged in many, many debates through the years over whether it’s better than our own. On such occasions I point out that (a) the U.S. system is more egalitarian than the Canadian system (and more egalitarian than the health systems of most other developed countries as well!), (b) uninsured Americans get as much or more preventive care than insured Canadians (as many or more mammograms, PSA tests, colonoscopies, etc.), (c) low-income whites in the United States are in better health than low-income whites in Canada, (d) although minorities do less well in both countries, we treat our minority populations better than the Canadians do, and (d) even though thousands of people in both countries go to hospital emergency rooms for care they can’t get anywhere else, people in our emergency rooms get treated quicker and better than they do in Canadian emergency rooms.

Now I know what you are wondering. Have I ever convinced anyone to change his mind with such arguments? Not on your life. Not when the opponent was a real, true blue collectivist. What I discovered after many frustrating conversations with people who seemed perfectly rational throughout was that those who like the way health care is organized in Canada do not like it because of any particular result it achieves. They like it because they like the process.

In Canada, what care you receive, where you receive it and how you receive it is not determined by individual choice and the marketplace. It is determined collectively. For collectivists, that’s an end in itself.
But collectivists never tell you they believe in process more than they believe in results.


Tweet: To the collectivist, on health reform policy it is the political process not the actual results that count.