Wednesday, June 10, 2009

Just What You Would Expect From A Conservative Rag

Call it a sign of things to come. The National Review Online has an article by Mona Charen titled Health-Care Bill Is The Ball Game. Indeed it is, and conservatives will try to win by cheating all the way to the goal line, if Charen's article is any indication of their tactics.

Though I included a link to the article, I can only recommend that you read it in the spirit of getting used to the lies and deceitful tactics that conservatives will employ in their fight to preserve the unacceptable status quo. But if your stomach is delicate, just read my analysis of the many distortions it contains.
The article, all seven paragraphs of it, is filled with all the misleading statements one would expect from a conservative rag hellbent on hiding its true intent: protecting big business, behind the cry of "more competition, not less."

Charen sets the stage by unleashing a dose of pedestrian sarcasm on President Obama, whom she accuses of having too many things on his hands already, so he should avoid trying to overhaul U.S. health care (as if things were just fine the way they are and we can afford to wait for the next Republican president to fix them).

Next she raises the ghost of "European statism", which conservatives like to use to rally the troops in defense of free market economy. I remember seeing a bumper sticker once that read something like "The media are as liberal as the conservative corporations that own them." If I were to rephrase it for the free market, I would say "The market is as free as the corporate oligarchs that dominate it allow it to be." But that's a topic for another article.

The third paragraph is where the real hack job begins. Charen brings up the fact that Obama's revamped health care system would end up like Medicare, "scheduled to go into bankruptcy by 2019." [Or even sooner, in 2017, at the current rate]. The data that Charen quotes is factual, but she fails to mention that one of the reasons why Medicare is going towards insolvency, according to Paul Krugman, is that "Medicare — originally a system in which the government paid people’s medical bills — is becoming, instead, a system in which the government pays the insurance industry to provide coverage", thanks to legislation introduced by the Republican Congress during George W. Bush's eight year reign.

Not yet satisfied, Charen then goes on to point to Mitt Romney's health care reform in Massachusetts as an example of how government plans typically exceed cost projections by a large margin. Here again she conveniently omits to mention that Romney's plan was centered around an insurance mandate, and that it contained no provisions to contain the sky-rocketing costs of insurance-provided health care. The plan's primary goal was to achieve universal coverage, not cost containment. The likely, if unstated, aim? To increase the amount of money that ended in the coffers of insurance companies. Predictably, then, the results are a mixed bag, and yet not the unmitigated disaster that Charen suggests it was. Either way, it is not a good example of how to proceed to reform health care in the United States.

The next accusation is that the number of of medical bankruptcies in the United States claimed by President Obama is inaccurate, and that the president greatly exaggerated the number of bankruptcies caused by medical bills. Whatever the case, and I am not getting into a contest with Charen here about which numbers are right, the president's or the ones she assumes, the fact that anyone could be driven to bankruptcy by their inability to pay medical bills is something that only the United States of America, which pretends to be a model for all to follow, would consider acceptable. In Italy we have a saying, which, loosely translated, means: "When you are in good health, you have all you need", the implication being that when a person enjoys good health, all good things follow naturally. Too bad Americans don't seem to have an equivalent saying, as it may help to change their callous attitude to health coverage matters. If they were to make one up, though, it would probably sound like "Good health is worth ruining your life over."

As the end of the article approaches, Charen starts focusing on the real (as in "real to her") culprits for the high cost of health care in the United States. The first culprit: too many mandates already.
State mandates require insurance companies to cover a variety of specialized medical services (usually at the behest of lobbyists for the relevant service providers) including: in vitro fertilization, marriage therapy, smoking-cessation classes, hormone-replacement therapy, chiropractor visits, and so on. That makes it impossible for companies to offer cheap, no-frills, high-deductible plans for the young and healthy. As Sally Pipes notes in The Top Ten Myths of American Health Care, there were only 252 mandates in force 30 years ago. Today there are 1,901, an average of 38 per state.

Take a look, for a moment, at the sample list of what Charen considers superfluous state mandates:
  • in vitro fertilization
  • marriage therapy
  • smoking-cessation classes
  • hormone-replacement therapy
  • chiropractor visits

The only item that legitimately belongs in the list is "chiropractor visits", since too many chiropractors should be in jail for promising treatment for things they can offer no cure for. Among the other items, the first thing that strikes me is that conservatives like Charen, who have exploited the religious right for political convenience, regard marriage therapy and in vitro fertilization as superfluous components of health care. You would think that if conservatives were honest about their ideological alignment with the religious right, they would consider marriage therapy as a desirable element of health coverage (sanctity of marriage, remember?) and in vitro fertilization as a desirable component of the culture of life (sanctity of life, remember?). But in order to demonstrate the damage that mandates do, Charen readily dismisses both points.

Smoking-cessation classes save states and insurance companies money, the assumption being that smoking causes long-term costs that are easily offset by the limited cost of smoking-cessation classes, so it is hard to understand what would be bad about this particular mandate if insurance companies would be otherwise reluctant to cover them.

Finally, Charen targets hormone-replacement therapy. So I quote the following paragraph from the NIH (National Institutes of Health):
In the years before and during menopause, the levels of female hormones can go up and down. This can cause symptoms such as hot flashes and vaginal dryness. Some women take hormone replacement therapy (HRT) to relieve these symptoms. HRT may also protect against osteoporosis.

Again, Charen's opposition is hard to understand, except in light of this sentence: "That makes it impossible for companies to offer cheap, no-frills, high-deductible plans for the young and healthy." So that's what it is! Charen thinks that young people, who conceivably are in better health and need less insurance coverage than older people, should be given the opportunity to purchase inexpensive plans for catastrophic coverage. Sounds reasonable? Yes, until you consider that this increases the cost of the remainder of the insured population, the people who are more likely to use (and sometimes abuse) more of their insurance coverage. Also, this position does not account for the fact that sometimes even young people would need coverage for things that, under a less expensive plan, would not be covered. Presumably, in such cases, they would be forced to pay retail prices for hospitalization and treatment not covered under their plan, prices which can be several times more expensive for the uninsured/uncovered than the rates negotiated by insurance companies with doctors and hospitals. So you see, in Charen's world insurance companies and hospitals never lose. For common folks it's just like setting foot in a health care casino: sometimes you come out even, but in the long run the house crushes you.

Going back to the subject of excessive mandates, there is another factor to consider, which Charen conveniently avoids to mention: pre-existing conditions. It is not that mandates do not exist to limit the ability of an insurance company or an employer to refuse insurance to an individual based on pre-existing conditions. It's the fact that there is really no limit to what the insurance company may charge the individual to cover pre-existing conditions, which practically forces a large number of individuals to either go without insurance altogether, or to go without coverage for the very condition that threatens them the most, or to move to a country with a humane health care system, if they have the opportunity and the means to do so.

Last word on the subject of mandates: lack of regulation does not enhance results for consumer. Just remember what lack of or relaxed regulations and enforcement have done to the nation in the banking and housing sector, just to mention a recent and dramatic example.

With two paragraphs remaining in her article, Charen focuses her attacks on the real culprits of the health care crisis: "Government involvement in the health-care system, through mandates, has reduced competition (such as forbidding shopping for insurance across state lines)." Charen does not know, or forgets to mention, a few facts. Read this article on the subject. First, it says, it is not a given that competition, in the sense of better coverage at lower costs, would ensue if interstate commerce of health insurance policies were permitted. Second, it states that in fact some insurers have themselves supported the introduction of certain state mandates, for reasons that the article explains. Additionally, Charen fails to explain that the existing limits on the sale of health insurance plans across state lines can be traced back to the McCarran-Ferguson Act of 1945. Since then (64 years ago) the alternance of Democratic and Republican administrations and Congresses have preferred not to mess with the McCarran-Ferguson act to enable the interstate sale of health care policies. Why? Is it perhaps because of the stifling influence of campaign contributions by the insurance industry to politicians, just to preserve the status quo? (Since 2000, the insurance industry has contributed close to $200 million to politicians, 36% to Democrats and 64% to Republicans. Add to these figures the fact that, in the same period, the health care industry has contributed $590 million dollars to politicians, 42% to Democrats and 58% to Republicans, and you will understand why the more things change the more they stay the same. If you don't believe me go to and check for yourself.)

Time for the final paragraph and Charen's conclusion: "If [President Obama] follows the lead of Great Britain, Canada, or other countries whose systems he admires, he can definitely bring down costs. He can do it the way they have, by rationing care." To support this claim, of course, Charen provides no evidence. (Throw the stone and hide the throwing hand.) Even if that were true, there are clear examples of things that a government backed plan could not and should not support, for example elective plastic surgery, ED medication, and--generally speaking--any treatment or service which can reasonably be deemed superfluous (and I am not talking about marriage therapy, in vitro fertilization, or the other things that Charen dismisses as superfluous). In any case, all you need to do to get a perspective on Charen's claims is to watch Michael Moore's Sicko to see how perilous a step in the British or Canadian direction would be for American patients (hint: not very). Or you can read this excellent article by Ezra Klein instead. Do either thing, or both, and you will be able to see Charen's warnings for what they are: more conservative scaremongering tactics.

"But Americans", concludes Charen, "should bear in mind this summer that when the president promises to get health-care costs under control he is really promising less care. There is a better way. More competition, not less. More market discipline, not less."

Before you rise to your feet and clap the skin off your hands in support of what you may view as Charen's perfect dismount, go and read The Cost Conundrum, Dr. Gawande's splendid and enlightening examination of the reasons why the town of McAllen, TX, has much higher health care costs, but no better hospitals, doctors, or outcomes than the not distant city of El Paso. (Hint: too much unnecessary health care, precisely the kind that Charen warns you you might lose. ) Dr. Gawande explains, in detail, more is not always better. To the contrary.

So there you have it, the witch hunt has begun, regardless of the fact that there are no witches to hunt, but millions of patients to treat without bankrupting them. But conservatives have already made it clear that they create their own reality, and the rest of us are left to comment on it. And that applies not only to military matters, but--apparently-to health care as well.

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