Why Conservatives Are Radical on Health Care

Posted by Barbara O'Brien at 1:00 PM on March 8, 2009.

The Obama administration wants to fix the nation's increasingly dysfunctional health care "system."

Wonks and politicians will have countless policy details to argue about. But all the details are boiling down to a contest between two basic approaches to delivering health care to Americans.

One approach is relatively incremental and might even be called "conservative." The other approach, however, would radically alter the way most Americans get their health care. It is completely untried and based on ideas that sound good on paper, but have no track record of working in the real world.

And here's the catch -- in the nation's mass media, the genuinely conservative approach is being called "radical," even "socialistic." The genuinely radical and untested approach is being offered by "conservatives."

President Obama's Conservative Health Care Proposal

Many of the details of President Barack Obama's health care initiatives have yet to be worked out. But the outline of his approach is extremely conservative compared to the way nearly all other industrialized democracies pay for health care.

Most Americans still seem not to know that the U.S. stands alone as the only First World nation with no national health care program in place. Around the globe, dozens of different approaches to national health care have been operating for several decades.

Some nations rely entirely on taxes to fund health care, while others have a mixed public and private system. Some systems do a good job of delivering first-rate health care, and, yes, others have big problems that we would want to avoid.

The point is that there is nothing at all "radical" about a national health care system. All the other countries have one. Or, at least, all the other countries affluent enough that most families own a microwave have one. Many less-affluent countries have them, also. Beside the United States, the only other nations on our globe that do not have national health care programs are poverty-ridden backwaters.

What Obama is proposing isn't even close to "socialized medicine," ravings by right-wing pundits notwithstanding. The private health insurance industry will remain in place. People who get health insurance as an employee benefit will still get health insurance as an employee benefit. People who want a private health insurance policy can still purchase one, if they can afford it.

Whatever government programs are created will be for people who are uninsured, and this is often because the private insurance industry won't accept them as customers. In the context of other nations' health care programs, this is about as conservative as it gets.

The Radical "Conservative" Solution

American conservatives call their approach to health care "market based" and "consumer driven." That sounds grand, but Americans need to pay close attention to the details.

Detail: The Right wants to phase out employee health benefits and push everyone into the private insurance market. This is an enormous change from the system we have now.

Competition and the forces of supply and demand will naturally push costs down, conservatives say. They claim a consumer-driven approach also will force individuals to make better lifestyle choices and discourage unnecessary tests and treatments, which will save money.

The people who push this approach call themselves "conservatives," but in truth it's the most radical proposal on the national table. Let's be clear: This so-called market-based approach is completely untried in modern times. No industrialized, democratic nation in the world is doing this. Certainly, nowhere on the planet is 21st century medical care being delivered using a "consumer-based" system.

Could it work? It sorta kinda makes sense, doesn't it? But there are huge flaws in this "conservative" approach. For one, the same people pushing "consumer-driven" health care don't want to burden the poor, struggling insurance corporations with nasty regulations about having to insure everyone, including sick people.

As they already do in many states, insurance providers could refuse to insure people with health risks. They could dump unprofitable patients at will, or force people who get sick to pay higher rates.

Again, this is the way health insurance companies operate in many states now, where state legislatures let them get by with it.

Scott Mitchell wrote in the February 2009 Harper's ("Sick in the head: Why America won't get the health-care system it needs"), "Ultimately, the entire nation could be reduced to two perfect circles: the people who pay for insurance and don't need it, and the people who need insurance but can't pay for it."

The 'Personal Responsibility' Gimmick

Then there's "personal responsibility." A conservative group called Conservatives for Patients' Rights (CPR -- clever, huh?) has "personal responsibility" as one of its four pillars of health care reform. Placing responsibility squarely where it belongs, on the shoulders of the patient, will encourage individuals to make to make healthy lifestyle choices," the site says.

Let's think about this. CPR suggests, without explicitly saying so, that people had better stay well or it will cost them. They expect our private health insurance providers to jack up our rates if we make claims, like auto insurers do.

Health insurance is supposed to work by pooling risk. The premiums paid by people who don't need expensive health care pay for the care of people who do.  This is fair over time, because, sooner or later, nearly everyone will need expensive health care. But sorting people into high-risk or low-risk pools means that getting sick puts you in financial jeopardy, insurance or no insurance. See above, "people who pay for insurance and don't need it, and the people who need insurance but can't pay for it."

Certainly, healthful lifestyle choices are commendable, and we might see the justice in expecting a chain smoker to pay more for the health problems he has brought on himself. But if higher risk of death doesn't deter smoking, why would higher risk of medical bills do the trick?

And wouldn't the threat of higher premiums discourage a person from getting prompt treatment for that nagging cough or funny-looking mole? And putting off treatment makes disease more expensive to treat. For this reason, many say the "personal responsibility" argument is bogus and will not reduce overall health care costs.

A healthful lifestyle is no guarantee of avoiding catastrophic medical problems. Healthy people have accidents. People enjoying healthful outdoor activities can contract Lyme disease. Healthful fruits and vegetables can be contaminated with E. coli bacteria. Healthful people can be exposed to deadly pollutants like asbestos, which causes mesothelioma, and not know it. Let's not penalize people for getting sick.

What Competition?

What about the claim that the force of competition will reduce health care costs? It's easy to see that competition can drive an electronics company to produce better and less-expensive MP3 players. But does this same principle apply to health care?

Let's say you have acute appendicitis. Do you spend the afternoon shopping for the least-expensive surgeon? Or do you accept whatever medical care your insurance company provides?

The simple fact is that purchasing health care is nothing like purchasing consumer electronics. If you want an MP3 player, you go to the electronics store and choose the one you want. But with health care, and the private health insurance industry, it's more like you purchase some sort of membership to the store, and the store chooses an MP3 player for you -- but only if it decides you really need one.

"Conservatives" argue that you can choose the insurance company that best suits your needs, which means insurance companies have to compete with other insurance companies for your business. To which I say, ha. If you have needs, they don't want your business.

Further, in 2007, the American Medical Association issued a report called "Competition in health insurance: A comprehensive study of U.S. markets" (PDF), which found that in many areas one big insurance company dominated the market.

In recent years, a few large companies have been buying smaller ones, further reducing consumer choice.  In 2007, just two insurance corporations -- WellPoint and United -- controlled 36 percent of the national market for commercial health insurance. That percentage is more likely to be higher today.

See also Maria Sanchez, "True Competition a Myth in the Private Health Insurance Marketplace."

Who's the Real Radical?

When people hear the word "conservative," they think it means something safe and tested that "conserves" established ways of doing things. That's what it means in dictionaries, after all. Maybe we should rewrite the dictionaries.

I cannot emphasize enough that the health care proposals being pushed by today's "conservatives" will radically change the way we all receive health care. Their ideas are completely untried anywhere in the world. And I say their theories have holes you could drive an ambulance through.

On the other hand, what Obama wants to do is leave alone what parts of the health care system are working and only change the parts that aren't working. People who are happy with their insurance coverage now will not have to change, he says.

If anything, some argue, that approach is too conservative, because the system needs a complete top-to-bottom overhaul. Many people would like to scrap the private insurance industry entirely and go to a single-payer system, in which health care costs are paid from a single government fund. If incremental changes don't work, we may get to that eventually. However, the Obama administration has declared that approach off the table, for now.

And, of course, the eventual details of the plan will be up to Congress. We don't yet know what those details will be. My fear is not that Democrats in Congress will come up with a plan that's too radical. Rather, I'm afraid they'll be too cautious, and millions will remain uninsured, while the premiums of others will remain ruinously high.

We'll see. Just understand that, right now, the real radicals are the "conservatives," and the real conservatives are being called "radicals." Don't be fooled by the labels.

Tagged as: health care, obama administration, right-wing health proposa

Barbara O'Brien is the "owner/proprietor" of the Mahablog. She also writes about Buddhism for About.com and about mesothelioma and asbestos tort reform for the Mesothelioma and Asbestos Awareness Center. She has contributed to many sites and guest blogged at the Take Back America Conference and Crooks and Liars.