Some Questions for Proponents of a National Government Run Health Insurance System

I have a significant number of friends who are in favor of a national government run health care insurance program.  They have touted its benefits.  Here are some questions I would like them to answer for me.  If you think they are leading questions with false or unfair premises, say so, but please try to answer them.

You think that state run insurance is a good idea.  You’ve seen in work well a fistful of countries.  You want to see it happen in the U.S..  Please consider and provide answers to the following questions:

1. The countries that you cite (France, Germany, Australia, Canada) as examples of successful state run health insurance have at most a population 1/4 the size of the United States. What makes you think that their systems can scale to the population of the U.S.?  Might there be cultural or governmental structure differences between the U.S. and these countries that would prevent their systems from translating correctly to a U.S. system?  Why or why not?

2. Why must state run health insurance be implemented at a national level instead of allowing individual states within the union to implement it at the state level if their own citizens want it?  Why must it be all states or none?  Massachusetts implemented mandatory health insurance with a state funded option for those who could not afford it under Governor Mitt Romney. Why not let it prove itself in state level laboratories? Why must it be national?

3. One astute technologist has observed: “any engineer knows that making large wholesale changes to complex open-loop dynamic systems (like the health care system) is a sure way to take a broken system and make it worse. If you’re a programmer, you’d never program like that. We don’t have to make public policy like that either. Refactoring 18% of the economy with one large bill is just plain nuts.”  Why must the changes to the health care system be implemented all at once right now?  Why not take an incremental approach?

4. Many of the same people who support a state run health insurance system also believe that big oil and other companies manipulated the national government during the Bush Administration to increase their profits by going to war. If big business can manipulate corrupt government in this way, what makes you think that if we give power to the government to control the medical industry that it wont be manipulated as well?  Your preferred party will not be in power forever.  Would you really want the party you disagree with to have the power you are granting?

5. Proponents of a national system often cite the supposed fact that 45 or more millions of people in the U.S. do not have health insurance.  However, a closer look at the numbers show that of those 45 million, there is a 6.4 million under-count of people who failed to report that they were on medicaid, 4.3 million who are eligible for medicaid or SCHIP but have not applied, 9.3 million who are not citizens of the U.S., and 5 million are single and young married adults without kids who choose to be uninsured.   If you believe that the Bush Administration “lied” about weapons of mass destruction in order to get us into the Iraq War, how is claiming 45 million uninsured in order to get us into a national health insurance system not a similar lie?  Are you okay with that?  Why or Why not?

6. Provided that you think that the system will scale, that it must be implemented on a national level and not a state level, that it must be implemented whole-hog and not incrementally,  that it will not be manipulated by corruption to unintended purposes, and that it is not being pushed using desceptive statistics– Upon what constitutional grounds does the national government claim power to run a state controlled insurance system that forces people to have insurance?  Interstate commerce clause? Preamble’s “general welfare” ?  How do you reconcile a national health insurance system with the 10th amendment?  Are there any existing national laws that force someone to purchase a product or service against their will?  What are the chances that the system will be found unconstitutional by the Supreme Court?

7. In order to get around the constraints imposed by the Constitution, a national health insurance program will likely have to be technically implemented by the states anyway with the threat of withheld funds from the national government. Many state Governors oppose the plan because they know that they will be the ones who have to implement it by national mandate. This hides some of the real cost by pushing off onto the states to keep it out of the national budget.  Are you okay with that?  Why?

8. Obama points to states where a single company has a complete monopoly on the health insurance industry, but he does not mention that companies are forbidden from competing across state lines by national law.  Would you be in favor of opening up health insurance competition across state lines as a way to bring costs down?  Why or why not?

9. In order to regulate health insurance on a national level, the government is going to have unprecedented access to your health care records and expenditures.  If you were against the Bush Administration’s warrantless wiretapping because of Constitutional privacy concerns, why do you not have similar concerns about the national governments invasion of private health information and profiling?

10.  The IRS will probably be the entity to audit health expenditure information on a national basis.  Considering the existing bureaucratic nightmare that is paying taxes, why do you trust the IRS to manage your health information?

11.  Part of the problem with the current system is that insurance plans do not move with the individual from job to job, or across state lines.  These are restrictions imposed or encouraged by the federal government.  Would you be in favor of eliminating these restrictions?  Why or why not?

I’m going to be out of the country for the next 12 days and wont have time to respond to comments during that time.  Take your time to consider the questions and provide some detailed answers and I will see what you have to say when I get back.

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5 Responses to Some Questions for Proponents of a National Government Run Health Insurance System

  1. Facebook User

    What? No answers or comments?

  2. Facebook User

    …quite telling…isn’t it.

  3. 1.Are you saying there are tasks that are just too big for the US to undertake? As far as the cultural question is concerned you are right, the Standard American Diet (S.A.D.)would make a nationalize healthcare system one of the most expensive one. According to the most recent World Health Organization report, the United States ranks 24th with a life expectancy of 70.0 years out of 191 nations. Japan ranks number 1 with a life expectancy of 74.5 years. Now the rest of the top 10 nations with high life expectancies follow: 2. Australia, 73.2 years; 3. France, 73.1; 4. Sweden, 73.0; 5. Spain, 72.8; 6. Italy, 72.7; 7. Greece, 72.5; 8. Switzerland, 72.5; 9. Monaco, 72.4; and 10. Andorra, 72.3. [http://www.who.int/inf-pr-2000/en/pr2000-life.html] We should note that these top 10 countries all have nationalize healthcare.

    2. Agreed, I think all state should have their own options but if the Mitt Romney plan works so well why should it not be implemented every where? Why have a million different wheels if we have one that works quite well. For the sake of simplicity would it not make sense to have a cohesive health plan throughout the United States? And economically speaking would not it be cheaper to have one cohesive plan throughout the country?

    3.Changing in increments makes sense. Over what period of time though? 10, 50, 100 years?

    4.I’m not sure I understand the predicament of that question fully. Countries who have state run healthcare have different political parties (for that matter more than 2) and healthcare is still running for everybody, no matter what their political affiliation. Was that the concerned?

    5)I fully agree that numbers can be manipulated to make them say whatever you want them to say and both parties use that to their full advantage. One cannot hide behind that truth to deny that there is a healthcare crisis. As a matter of fact medical bills prompt more than 60% of all US bankrupcies (from people who have insurance). http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/
    I see a weird dichotomy in your predicaments though. One is lying to go to war and create death, the other is lying to create a better healthcare for a general population and save lives. Which of these two lies is worse?

    6. I’ll be honest I don’t know if it’s a state or federal law but I am forced to purchase auto insurance in order to legally drive my car. Also I am forced to vaccinate my children in order to have them in public school. But what about Medicare and the 10th Amendment then? Isn’t Medicare forced upon us? I sure pay for it every month! Should we go to the Supreme Court to abolish Medicare as it is a violation of the 10th amendment?

    7. Are you ok with the imposed Medicare program? If not, why?

    8.I agree they should, as well as abolish the anti-trust exemption. Now does not it stand to reason though, that sooner or later if we were to open state borders those major companies would re-align their prices? Do you think they would choose the lower premiums or the higher premiums in this price realignment? The reality is that the industry is really controlled by only a handful of companies: BCBS, Aetna, Kaiser, United healthcare. Open up state lines and the small companies will be either bought over or die. Isn’t it why they closed up state lines in the first place?

    9.Ok so the private sector can have access to all your medical information and profile you, but not the government cause it would be different, how?
    First of all the government already has access to medical records, hello Medicare!!! Second the private sector aligns their profiling to you guess who: Medicare!!!! Medicare guidelines are the private sector’s guidelines.
    Now if you think the private sector is so much better than the state run one you are in for a lot of disillusion as soon as you are going to be faced with a serious illness (which I do not wish on anybody). For instance the private sector can drop you at anytime once they consider your physical ailment a liability to them. For instance if you were ever diagnosed with Fibromyalgia, Chron’s disease, Ulcerative Colitis, Cancer, HIV etc,etc, etc, good luck finding a private insurance to cover you if you decide to leave corporate America to work for yourself/own your own business. And if you get diagnosed with these terrible ailments while working for yourself you will get dropped like a rock, not matter if you paid high premiums for 10, 15 years. It’s part of their contract, read the small prints. It happens everyday.
    Again the private sector controls and decides what kind of care they will let you have access to. The medical doctor will tell you, you need this and that to get better but your insurance will tell you, we will only pay for this because that one is considered experimental (understand:too expensive for our taste).

    Again 60% of bankruptcies in the US are medically related (from people who had insurance)

    Also I would like to remind the audience that most industrialized nations have government run healthcare and it has never affected the private lives of their citizens. There are no death panels in Europe, lol!

    10.You’re right so let’s create another entity all together, another branch of government dedicated to that function. Oh wait, it already exists, it’s called Medicare.

    11.I’m all about it, which means again that we need cohesiveness throughout the nation. Which means all plans will have to realign themselves. See number 8

  4. Jean-luc,

    Thanks for your thoughts. My responses:

    1.a. It is not a question of whether the task is too big for the U.S., but whether correct principles of government and prudence should permit government to solve certain problems, and at what level of government they should be handled.

    1.b. Comparing life expectancies, when even you acknowledge that there are more than just health care system factors (ie diet) is simply not a valid argument for nationalized health care. Since you freely admit that the American diet contributes to the lower life expectancy, then there is no reason to expect that implementing a national health system would change the life expectancy.

    2. If a system in a specific state does work as well as is claimed, it will be quickly adopted by the other states with having to be forced from a national level. If it is good, the people will voluntarily adopt it in their states. If it has to be forced nationally from the top down it probably isn’t truly good. Economically speaking, things are managed with less waste closer to the local level where regional differences can be taken into account and adjustments made. A one size fits all system at the national level ends up being less effective and more expensive.

    3. If a good system emerges in one state, the other states will adopt it quickly.

    4. Nationalizing the health care system only changes the arena in which the battles and corruption are played out. The greater the power and more extensive the reach, the greater the incentive to manipulate it. If the government were to provide insurance, where do you think they will get the personnel to manage and run this system? They’ll need people who are already experienced, which means they’ll hire from the insurance industry. The corruption just moves to a new, more powerful venue.

    5. If the bush administration lied to get us into the war it wasn’t to create death, that was just a side effect. The objective was to gain power and money. Those who lie to establish a national health system aren’t trying to save lives, their objective is to gain power and money. Both are lying to get power, regardless of the stated objective. Neither one is defensible. I do not deny that the health care system is terribly broken and needs to change. But that does not mean that the best solution is a national system.

    6. Auto insurance is a state law. And driving is a privilege, not a right. That is why you have to get a license to do it. You can choose not to drive. Plus, you do not use your auto insurance to pay for gas or routine auto maintenance. It is for accidents. But we do use our medical insurance to pay for routine doctor’s visits and care. That is part of why it is broken.

    More later…as time permits.

  5. 1. Considering the previous administration screwed us up royally draining the budget surplus and borrowing from the Chinese to support a foolish war, I can only but agree that a government should act with prudence when dealing with domestic affairs…
    b)If I were president I would make high fructose corn syrup and fried food illegal which would solve half of the health disease process in this country (obesity, Cardiovascular disease, Diabetes…) Realistically speaking what are the chances of that happening? You will have better luck changing the health care system than changing the standard American diet. Thus being said, if more people had access to quality health care in this country I think you would see a rise in the life expectency. There would also be more public campaigns about awareness and prevention.

    2. So far no good plan apparently because nobody is changing anything. Even though we all agree that the system is broken. Well they did change things around Massachusetts with the Mitt Romney plan but it’s far from ideal. Yes they’ve got more people covered by insurance plan than any other state but sadly enough the deductibles of this plan are so high that nobody uses them!
    So much for leaving it to local governments. Plus most of these local politicians are such in need of the Health Insurance lobbying money for their campaigns that it is unlikely that things will change any time soon.

    4. so if it’s doomed from the get go what are you suggesting? You recognize that the system is corrupt but you are willing to let it go as is? Let’s just sit on our hands?

    5. The Bush objective was greed and personal gratification (needed to impress daddy) which resulted in a lot of death and chaos. Anybody who’s trying to establish a state run healthcare system will gain no power nor wealth from it. Can you please tell me how Lyndon B. Johnson got wealthy from signing into law the Medicare bill? Political recognition and “glory” maybe (from people who approve) but there is no money to be made from a state run health program, let’s be real! :-)

    6. Help me out are you a libertarian, a tea party guy or just a staunch Republican. Not that I am trying to put you in a box but sometimes the stuff you say sound more libertarian in nature and then bam you turn things around and all of a sudden you’re a staunch Republican!
    I mean seriously using your previous argument where is it in the constitution that I should be forced to pay for auto insurance? Who made it a “privilege” to drive? Privileges? I thought we had done away with privileges with the revolution, lol. Besides you still don’t answer the question. Should we go to the Supreme Court to abolish Medicare as it is clearly an infringement of the 10th amendment. If you have grandparents alive, you should bring it up to them, I’d be curious to hear their answer. ;-)
    I will tell you what, the fact that we use health insurance for routine visit is not what make the system broken, far from it (and back to the car analogy you can use your car insurance to replace a cracked windshield)
    What makes the system broken is greed. Greed from Health Insurance Companies (they are from lacking), then greed from the medical profession (have you ever had an itemized bill for an hospital stay, just for an uncomplicated pregnancy for instance, items like a box of gauze $50.00 (12 pads in a box), greed from the pharmaceutical industry. Drugs are more expensive in the US than anywhere else for the same drug. You can buy a box of Ibuprofen (Doliprane)in France for 1.50 Euros (no insurance involved), Tylenol is about $10+ depending on the type of caps. There’s a reason a reason for it, the heavy marketing (TV commercials) and the heavy lobbying.

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