Map of life expectancy at birth from Global Education Project.

Thursday, July 19, 2007


Sorry, the last couple of days my Irrational Bush Hatred, combined with Intermittent Explosive Disorder, have gotten the better of me and interfered with high quality posting. Having taken my Selective Serotonin Reuptake Inhibitor, Atypical Antipsychotic, Antianxiolytic, and Mood Stabilizer, I am now once again the very picture of glowing mental health.

And so, turning to the news of the day, George W. Bush, who I no longer irrationally hate, has vowed to veto reauthorization of the Supplemental Children's Health Insurance Program (S-CHIP) on "philosophical grounds," specifically, "when you expand eligibility . . . you're really beginning to open up an avenue for people to switch from private insurance to the government." Now, I'm not sure which philosophy that is. It doesn't really sound like transcendentalism, or logical positivism, or empiricism . . . hmm.

I know! It's the philosphy that insurance companies give money to Republicans.

If you're going to say that it is bad for people to have government-run insurance instead of private insurance, you probably ought to tell us why you think that is bad. As you know if you've been reading, we spend about 25% of our health insurance dollar on the administrative costs of private insurance -- marketing, profits, and paying rooms full of drudges to figure out ways to deny people coverage. Our largest publicly funded program, Medicare, has administrative costs under 3%, and has simple rules about what is and is not covered that are largely based on whether drugs and procedures are approved as safe and effective. (Long term care is not covered, which is a separate issue, along with the doughnut hole in drug coverage. But few people see these omissions as virtuous on philosophical grounds.)

Veterans in this country have not just public insurance, but actual socialized medicine. It's inadequately funded right now because Mr. Bush pretended their wouldn't be any casualties from his splendid little war, but the public is demanding that it be fixed, not privatized. Does a public insurance system mean "rationing" and cost controls? Yes it does. Mr. Bush invokes those terms to scare us, but why are they supposed to be scary?

We have rationing right now -- 45 million people who have no insurance and who don't get preventive care and basic services, and people with private insurance whose insurers ration their care in order to pump up profits. What we need is rational rationing, where we allocate services based on their expected benefits vs. their costs. That's what they do in all the civilized countries of the world.

And the civilized countries have cost controls, which we don't. That means they save money -- lots and lots of money. They spend, typically, half as much on medical services as we do, and they get more for it. Mr. Bush is opposed to that, it seems, on philosophical grounds.

So I would really like to learn more about this philosophy. Is it the philosophy his Economics 101 professor taught him? Maybe he'll explain it to us some day.

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