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My View On Healthcare Reform

Posted by: Michael Mandel on September 09

As we wait for Obama’s speech tonight, I can’t do any better than to channel Andrew Sullivan:

the end-result looks to me more and more like a simple extension of healthcare security to a lot of people without any real or strong mechanisms to curtail the soaring costs that are bankrupting the country and putting so much strain on US business. Of course, I belong in that archaic camp that believes it is the job of a liberal president to expand such coverage and the job of a conservative opposition to propose ways to afford it

Cover the uncovered, reduce health insecurity for people who lose their jobs—these are worthwhile and achievable goals. Then the fiscal conservatives can have their turn.

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Reader Comments


September 9, 2009 04:35 PM

I believe it is moral to try to find a way to get everyone healthcare if we can afford it. But part of the problem is the cost is rising to the point where it's not clear we can (at least under current definitions of what health insurance should mean). If health care were cheap and effective, health insurance would be affordable, but the reason the debate has become acute is because the affordability isn't there: or is the argument that it *would* be affordable if a mandate meant there were no free riders (except illegal aliens)?

Brandon W

September 9, 2009 05:19 PM

There are three ways to reduce the costs, which we should be addressing: 1) increase supply of health care provision, 2) decrease demand on health care provision, 3) improve efficiency.

1) Increase the supply. The American Medical Association and other medical lobbies have pushed the government into severe restriction on the provision of health care, thus limiting supply. Most basic health care could be provided by degreed nurses and physician assistants. Naturopathic Doctors should be allowed to practice as regular physicians; because if Americans are allowed to have free choice in how their health is cared for, they should be allowed the freedom to choose Naturopathic care. Break the AMA lobby's grip and open up health care practice to providers who are perfectly trained and capable of doing so.

2) Decrease demand. f it comes from a food system that is economically rewarded to produce food of lower nutrient-density and higher sugar content (including refined carbohydrates). In 1830 Americans ate 15 lbs of sugar per year. We now eat over 150 lbs of sugar per year. We have more calories than we need, but Americans are literally starving of proper nutrients. Rates of disease have increased dramatically in the past 50 yrs, though deaths may have held steady (or even declined). More disease, but it's mediated by extensive health care and pharmaceuticals.... at a price. Start with the elimination of a system that subsidizes the growing of corn, which is processed into disasterous ingredients such as High Fructose Corn Syrup as well as used to feed cattle and chickens for which the corn is not a natural food and not producing healthy meat for our food system. (As a side note, foods with HFCS were recently discovered to contain high levels of the toxic element mercury, due to the process used on corn to create the HFCS). Make the destruction of whole grains for use in the food system illegal (i.e. no more refined carbohydrates). Stop allowing - or even encouraging - food producers to produce foods that are destroying our health. Also, allow assisted suicide to remove dying patients from being a (very expensive) drag on the health care system. The insurance system should also not be required to pay on any treatment that is only expected to extend life 6 months or less (huge costs are incurred by these end-of-life treatments).

3) Improve efficiency. Having all medical records in an information system that uses an interchangeable format (so records can be ported to other hospital systems, etc.) would decrease errors and records costs. Mandating this for all health care providers would reduce costs. Where my wife works, they're still using "hard charts" - i.e. paper charts - to manage medical records and care. More controversially, a single-payer national insurance system would be more efficient. In a paper I researched and wrote in 2003, I found that U.S. health care has about 20%-25% administrative overhead, whereas single-payer systems have about a 4%-6% administrative overhead. Single-payer systems are more efficient. Their faults are not different from the faults of supply and demand that I discussed in points 1) and 2). Solve the supply and demand, and a single-payer system will work effectively and efficiently, and help reduce overall costs.


September 9, 2009 07:55 PM

You could not come up with a more stupid formulation than taking "turns" at medical policy. The reason the uninsured can't afford medicine is because of this crazy system where providers jack up their prices with markups of 100-200% so that the government, which accounts for 45% of medical spending, will actually pay for their costs. Increasing this moronic system by extending "coverage" is digging the ditch deeper, which Obozo the clown probably neither knows or cares about. Rather, McCain provided the solution last year, removing the tax breaks for employer-provided insurance while moving people into medical savings accounts and real insurance, meaning catastrophic insurance, which Obozo moronically and maliciously demagogued as "the end of employer-provided insurance," perfectly demonstrating how he's simply the natural extension of politics into an even more vacuous and dangerous form.


September 10, 2009 07:03 AM

The problem of providing healthcare is increasing and making it unaffordable for most especially diseases that require complicated surgery,or longterm care. we can reduce costs by disallowing treatment for persons above 70----i am 70,out of public funds.also for diseases that will result in death for people who will die soon with or without treatment,reducing the profit on drugs,no public funding for infertility tretment,limit number of births. educate children suitably,they will not fight death when it is inevitable,accept it as part of life,like turning a page.

Brandon W

September 10, 2009 03:24 PM

Correction on above post. Somehow I highlighted the first part of the sentence and deleted it but didn't notice (curse you laptop touchpad!):

2) Decrease demand. Americans are in horrible health. Some of this comes from insufficient exercise, but most of it comes from a food system that.....

Mike Reardon

September 11, 2009 02:16 AM

Hold 2001 to 2008 in its a historic view when seeing a system like Health Care that expanded well beyond the rate of inflation. If Health Care over this same time went 286% above the inflation rate, it also had its political and as much lobbing support in gaining its share of greater returns to investors as any other level of business. A time of open bubble economy with asset inflations in housing leveraged by consumers financing and leveraged debt throughout business, and massive public debt created by government. And the massive transfer of world liquidity in exchange for a direct labor transfer. All lifting the economy to return always greater returns to investors pushed stocks to always newer highs up to 2007.

You can be sure the Bush Administration and the Republican Congress was applauding all the Health Care stocks returning greater returns to investors. The same people in Congress, on both sides, who now are yelling cost containment, and no debt obligation following any reform, were the same who gave the system its passes to gain those returns on greater profits and legislated any request the lobbyists demanded to gain those Health Care profits returns. That and keeping up with the wealth effect is everything in place now. Like Oil and Gas and Electricity over that time, that was the way things were done.

It is the standard they are still trying to maintain but it can’t be sustained because that bubble economy is now completely flat.

59% have employer based Health Care, and 21% have State or Federal Health Care, only 18% are without any access to Health Care. That 18%, is 47 million without, but because of job churn over a period of 2 year that expand at times to over 60 million separated with out coverage. Health Care expansion to that last 18% becomes in fact a real domestic infrastructure investment.

Everything from here likely will be only by our bootstraps, an economy that sits flat and gains growth only with real organic domestic investments, and totally without the bubble effects we have lived off of for the last five years. What is wrong with the cost of that investment, it must now also reform the rest of the present bubble Health Care system we have in place now that lobbyists are still fighting to keep in place.

Without Health Care expansion and a payment system under it with government support, every new corporate bankruptcy will only dump thousands more onto the uninsured rolls. GM and Chrysler bailouts, look no further than adding 2 million more without Health Care as the start of 2009. We could be now finding funding for 49 million without Health Care instead of 47 million.

Thank you for your interest. This blog is no longer active.



Michael Mandel, BW's award-winning chief economist, provides his unique perspective on the hot economic issues of the day. From globalization to the future of work to the ups and downs of the financial markets, Mandel-named 2006 economic journalist of the year by the World Leadership Forum-offers cutting edge analysis and commentary.

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