Response to Patrick Poole re Health Care Crisis

As someone who takes strong positions on hot button issues, I expect that people will disagree with me.  I also expect that people will attack me, frequently without responding to the specific arguments I make.  Unfortunately, Patrick Poole's piece yesterday on American Thinker ("Health Insurance and 'Adequate' Care") meets my expectations.

Let me begin by making clear that I do not deny that there are "problems" with our health care system.  Contrary to Mr. Poole's pop psychoanalysis, I do not live in a "fairy-tale world" or believe that "the problems within our health care system [will] magically disappear."  I agree that there are many problems with the health care system in this country, some of which I touch on below. 

But it is far from obvious that the conventional wisdom that the system itself is "broken" or in "crisis," which Mr. Poole subscribes to, is correct.  Moreover, it is my firm belief that talk about the "health care crisis" is intended to justify greater government control over the health care industry, i.e., socialized medicine.  See Paul Krugman.  (Just as hysteria over global warming is intended to justify greater government control over the energy and transportation sectors of the economy.  See Al Gore.)  Rarely does one find a pundit or policy maker who believes there is a "health care crisis" but who does not also believe that the "solution" to the crisis requires more government intervention. 

Perhaps Mr. Poole is one of these people.  For example, in his latest piece he argues that "government interventionism is the root cause of most if not all of the distortion in our health care market."  However, in two articles on the subject, he has yet to describe a non-socialistic solution to the problem he identifies of millions of people without health insurance (according to Paul Krugman, 47 million). 

Indeed, Mr. Poole bemoans the "tragedy" and "plight" of the uninsured, without offering any concrete information as to who are the people who make up the uninsured (approximately 25 percent of whom are recent immigrants, mostly illegal); why people are uninsured, whether by choice, out of ignorance, due to poverty, due to failure to sign up for existing public insurance programs like Medicaid, or due to a lack of affordable health insurance options for working and middle-class people as a result of excessive government regulation of the insurance industry; nor does he address the very important question of how long such people remain in the ranks of the uninsured.  Without such information, I do not believe it is possible to analyze the problem of the uninsured with the requisite degree of objectivity and judgment. 

Most glaringly, despite acknowledging my position that the vast majority of people living in this country obtain more than adequate medical care (not, as Mr. Poole tendentiously wrote, that "everyone gets the health care they need regardless of their ability to pay"), Mr. Poole offers no data, no statistics, no research studies, nothing, to prove me wrong.  If such data and studies exist, I will be more than happy to reconsider my position.  But Mr. Poole, a former policy analyst for the Tennessee Institute for Public Policy, merely offers his own anecdotal experiences during a particularly unfortunate period in his life.  At the risk of sounding cold-hearted, I must say that this isn't good enough.  Anecdotes may help to illustrate issues, but they prove nothing about the scope or importance of these issues from a public policy perspective.  Before the country blithely acquiesces in the socialization, and inevitable degradation, of our health care industry, I think a much more compelling case than this has to be made.

So, what do I think "needs to be done" about the health care system?  I confess I don't have a complete answer to this question, but here are some preliminary thoughts:   

First, above all, we need to dispense with the true "fairy-tale" belief -- which is that everyone in this country should receive "the best health care someone else's money can buy."  The point of this joke is simply that, as rich as we are, we are not nearly rich enough to provide every person in this country with the same amount and quality of health care as can be afforded by the richest members of our society.  If this offends you, I'm sorry.  But denying the truth won't make it go away. 

As I mentioned in my initial comment on Wednesday ("Lack of Health Insurance is Not the Problem"), having the best doctors, the best technology, the most advanced drugs, and the most sophisticated procedures costs a lot of money -- more money than most people can afford to spend on health care.  In this sense, health care is no different than any other "big ticket" consumer item, like housing, or automobiles, or education.  Not everyone can afford the best.  Many people, therefore, are going to have to accept less.  Moreover, just as we cannot afford, as a society, to provide every family with a 3,000 square foot home full of top-of-the-line appliances, or a Rolls Royce and Hummer in the garage, or a $500,000 education (K through college) at the toniest private schools, we cannot afford to provide every person with the highest quality medical care.  We just can't -- even if we were to use the government to loot all of the wealth in the country and force doctors to provide services for free.

Yes, as we get richer, and as we continue to make advances in health care, the average level of medical care available to all Americans will continue to go up, just as it has for decades and decades.  But, significantly, this only will happen if we operate under a free market system, based on the profit motive.  Once we decide to make health care a "right" and declare that all persons are "entitled" to medical care -- as we already are doing through massive top-down programs like Medicare; through laws that require hospitals to care for all persons, regardless of ability to pay; and through government mandates that require insurance companies to provide various types of coverage, regardless of the realities of the marketplace -- then we will stifle the very engine of progress, and create the same stagnant, unresponsive health care systems that exist in Britain and Canada. 

Do such socialized health care systems work "better" for the poorest members of those societies than a free market system would?  I am sure they do.  (Just as declaring a constitutional right to public housing would work "better" for the homeless than our current, overwhelmingly private system does.)  But the price of such systems -- besides a devastating erosion of personal and economic liberty in one of the most important areas of life -- is that the amount and quality of medical care available to the vast majority of citizens is made demonstrably worse.  On what political, economic, or moral grounds should the vast majority of Americans be required -- on pain of government coercion -- to sacrifice their own health care choices in order to remedy a "problem" (lack of health insurance) that exists for no more than 10-20 percent of the population (including millions of illegal aliens who do not belong here)?  I can't think of any that I find remotely persuasive.  Mr. Poole suggests that such "utilitarian" thinking is misplaced in this debate.  I strongly disagree. 

It is no coincidence that people the world over want to come to the United States, with still the freest health care system of any advanced country, for medical care.  Nevertheless, more and more Americans are jumping on the socialized medicine bandwagon.  Clearly, many people believe that "government" can provide for their health care needs better than they can.  As discussed above, this is a deeply mistaken point of view.  Unfortunately, it is a view that large numbers of people hold, not just the "trojan horse liberals" (as my brother calls them) who want to sneak socialism into the country through seemingly "compassionate" liberal social policies.  The country will rue the day when we succumb to the siren song of "universal coverage."

Besides re-invigorating the free market aspects of the health care industry, e.g., through insurance de-regulation and health savings accounts, what else do I think needs to be done?  Briefly, we absolutely must secure our borders and reduce the number of illegal immigrants streaming into the country.  Illegal immigrants represent a severe drain on our health care system (indeed, on all aspects of our society) to the tune of billions of dollars annually.  Our country, however rich, does not have limitless resources.  Every dollar spent caring for illegal immigrants, e.g., in hospital emergency rooms and OB wards, is one less dollar that can be spent on Americans.

We also need tort reform.  Both the corporations that research and develop new health care products and individual health care providers in this country are subjected to lawsuits that impose millions, sometimes billions, of dollars of costs on them, and, indirectly, on American consumers.  These costs drive companies and doctors out of business, reduce innovation, lead to inefficient "defensive" medicine practices, raise insurance costs, and ultimately reduce the amount and quality of medical care available to Americans. 

Do I think all such lawsuits are baseless?  Of course not.  But too often in products liability and medical malpractice cases, the alleged "wrongdoing" is highly debatable (a "battle of experts" as we say in the legal profession), and juries tend to award damages out of sympathy for the "victim" rather than an understanding of the medical science or standard of care involved.  Many tort reform proposals have been made over the years, usually to impose some sort of cap on damages.  Personally, I think raising the burden of proof in these cases, from a preponderance standard to a clear and convincing standard, is the single most important reform we should make.  I believe that debatable cases should be resolved in favor of the defendant.  Only where the negligence is clear should damages be awarded.  And in those cases, very large damages may sometimes be appropriate.

In closing, do I think that the policies I support -- health care de-regulation, reducing illegal immigration, and tort reform -- will eliminate all problems with the health care system, or allow all Americans to receive the medical care they want?  Of course not.  No such policies, including "universal coverage" or any other scheme of socialized medicine, can achieve these utopian goals.  On the contrary, the existing examples of state-run health care systems across the world demonstrate that they lead to worse medical care for more people, by far, than the American system.  Again, I challenge anyone to prove me wrong.

Steven M. Warshawsky 
As someone who takes strong positions on hot button issues, I expect that people will disagree with me.  I also expect that people will attack me, frequently without responding to the specific arguments I make.  Unfortunately, Patrick Poole's piece yesterday on American Thinker ("Health Insurance and 'Adequate' Care") meets my expectations.

Let me begin by making clear that I do not deny that there are "problems" with our health care system.  Contrary to Mr. Poole's pop psychoanalysis, I do not live in a "fairy-tale world" or believe that "the problems within our health care system [will] magically disappear."  I agree that there are many problems with the health care system in this country, some of which I touch on below. 

But it is far from obvious that the conventional wisdom that the system itself is "broken" or in "crisis," which Mr. Poole subscribes to, is correct.  Moreover, it is my firm belief that talk about the "health care crisis" is intended to justify greater government control over the health care industry, i.e., socialized medicine.  See Paul Krugman.  (Just as hysteria over global warming is intended to justify greater government control over the energy and transportation sectors of the economy.  See Al Gore.)  Rarely does one find a pundit or policy maker who believes there is a "health care crisis" but who does not also believe that the "solution" to the crisis requires more government intervention. 

Perhaps Mr. Poole is one of these people.  For example, in his latest piece he argues that "government interventionism is the root cause of most if not all of the distortion in our health care market."  However, in two articles on the subject, he has yet to describe a non-socialistic solution to the problem he identifies of millions of people without health insurance (according to Paul Krugman, 47 million). 

Indeed, Mr. Poole bemoans the "tragedy" and "plight" of the uninsured, without offering any concrete information as to who are the people who make up the uninsured (approximately 25 percent of whom are recent immigrants, mostly illegal); why people are uninsured, whether by choice, out of ignorance, due to poverty, due to failure to sign up for existing public insurance programs like Medicaid, or due to a lack of affordable health insurance options for working and middle-class people as a result of excessive government regulation of the insurance industry; nor does he address the very important question of how long such people remain in the ranks of the uninsured.  Without such information, I do not believe it is possible to analyze the problem of the uninsured with the requisite degree of objectivity and judgment. 

Most glaringly, despite acknowledging my position that the vast majority of people living in this country obtain more than adequate medical care (not, as Mr. Poole tendentiously wrote, that "everyone gets the health care they need regardless of their ability to pay"), Mr. Poole offers no data, no statistics, no research studies, nothing, to prove me wrong.  If such data and studies exist, I will be more than happy to reconsider my position.  But Mr. Poole, a former policy analyst for the Tennessee Institute for Public Policy, merely offers his own anecdotal experiences during a particularly unfortunate period in his life.  At the risk of sounding cold-hearted, I must say that this isn't good enough.  Anecdotes may help to illustrate issues, but they prove nothing about the scope or importance of these issues from a public policy perspective.  Before the country blithely acquiesces in the socialization, and inevitable degradation, of our health care industry, I think a much more compelling case than this has to be made.

So, what do I think "needs to be done" about the health care system?  I confess I don't have a complete answer to this question, but here are some preliminary thoughts:   

First, above all, we need to dispense with the true "fairy-tale" belief -- which is that everyone in this country should receive "the best health care someone else's money can buy."  The point of this joke is simply that, as rich as we are, we are not nearly rich enough to provide every person in this country with the same amount and quality of health care as can be afforded by the richest members of our society.  If this offends you, I'm sorry.  But denying the truth won't make it go away. 

As I mentioned in my initial comment on Wednesday ("Lack of Health Insurance is Not the Problem"), having the best doctors, the best technology, the most advanced drugs, and the most sophisticated procedures costs a lot of money -- more money than most people can afford to spend on health care.  In this sense, health care is no different than any other "big ticket" consumer item, like housing, or automobiles, or education.  Not everyone can afford the best.  Many people, therefore, are going to have to accept less.  Moreover, just as we cannot afford, as a society, to provide every family with a 3,000 square foot home full of top-of-the-line appliances, or a Rolls Royce and Hummer in the garage, or a $500,000 education (K through college) at the toniest private schools, we cannot afford to provide every person with the highest quality medical care.  We just can't -- even if we were to use the government to loot all of the wealth in the country and force doctors to provide services for free.

Yes, as we get richer, and as we continue to make advances in health care, the average level of medical care available to all Americans will continue to go up, just as it has for decades and decades.  But, significantly, this only will happen if we operate under a free market system, based on the profit motive.  Once we decide to make health care a "right" and declare that all persons are "entitled" to medical care -- as we already are doing through massive top-down programs like Medicare; through laws that require hospitals to care for all persons, regardless of ability to pay; and through government mandates that require insurance companies to provide various types of coverage, regardless of the realities of the marketplace -- then we will stifle the very engine of progress, and create the same stagnant, unresponsive health care systems that exist in Britain and Canada. 

Do such socialized health care systems work "better" for the poorest members of those societies than a free market system would?  I am sure they do.  (Just as declaring a constitutional right to public housing would work "better" for the homeless than our current, overwhelmingly private system does.)  But the price of such systems -- besides a devastating erosion of personal and economic liberty in one of the most important areas of life -- is that the amount and quality of medical care available to the vast majority of citizens is made demonstrably worse.  On what political, economic, or moral grounds should the vast majority of Americans be required -- on pain of government coercion -- to sacrifice their own health care choices in order to remedy a "problem" (lack of health insurance) that exists for no more than 10-20 percent of the population (including millions of illegal aliens who do not belong here)?  I can't think of any that I find remotely persuasive.  Mr. Poole suggests that such "utilitarian" thinking is misplaced in this debate.  I strongly disagree. 

It is no coincidence that people the world over want to come to the United States, with still the freest health care system of any advanced country, for medical care.  Nevertheless, more and more Americans are jumping on the socialized medicine bandwagon.  Clearly, many people believe that "government" can provide for their health care needs better than they can.  As discussed above, this is a deeply mistaken point of view.  Unfortunately, it is a view that large numbers of people hold, not just the "trojan horse liberals" (as my brother calls them) who want to sneak socialism into the country through seemingly "compassionate" liberal social policies.  The country will rue the day when we succumb to the siren song of "universal coverage."

Besides re-invigorating the free market aspects of the health care industry, e.g., through insurance de-regulation and health savings accounts, what else do I think needs to be done?  Briefly, we absolutely must secure our borders and reduce the number of illegal immigrants streaming into the country.  Illegal immigrants represent a severe drain on our health care system (indeed, on all aspects of our society) to the tune of billions of dollars annually.  Our country, however rich, does not have limitless resources.  Every dollar spent caring for illegal immigrants, e.g., in hospital emergency rooms and OB wards, is one less dollar that can be spent on Americans.

We also need tort reform.  Both the corporations that research and develop new health care products and individual health care providers in this country are subjected to lawsuits that impose millions, sometimes billions, of dollars of costs on them, and, indirectly, on American consumers.  These costs drive companies and doctors out of business, reduce innovation, lead to inefficient "defensive" medicine practices, raise insurance costs, and ultimately reduce the amount and quality of medical care available to Americans. 

Do I think all such lawsuits are baseless?  Of course not.  But too often in products liability and medical malpractice cases, the alleged "wrongdoing" is highly debatable (a "battle of experts" as we say in the legal profession), and juries tend to award damages out of sympathy for the "victim" rather than an understanding of the medical science or standard of care involved.  Many tort reform proposals have been made over the years, usually to impose some sort of cap on damages.  Personally, I think raising the burden of proof in these cases, from a preponderance standard to a clear and convincing standard, is the single most important reform we should make.  I believe that debatable cases should be resolved in favor of the defendant.  Only where the negligence is clear should damages be awarded.  And in those cases, very large damages may sometimes be appropriate.

In closing, do I think that the policies I support -- health care de-regulation, reducing illegal immigration, and tort reform -- will eliminate all problems with the health care system, or allow all Americans to receive the medical care they want?  Of course not.  No such policies, including "universal coverage" or any other scheme of socialized medicine, can achieve these utopian goals.  On the contrary, the existing examples of state-run health care systems across the world demonstrate that they lead to worse medical care for more people, by far, than the American system.  Again, I challenge anyone to prove me wrong.

Steven M. Warshawsky