Don’t take this the wrong way

by on July 21, 2009 at 5:33 am in Medicine, Political Science | Permalink

The prospects for health care reform seem to be dimming.  If I were a progressive I would be wondering right now whether Medicare was a tactical mistake.  The passage of Medicare meant that most old people get government-provided health care coverage.  Yet the way to get things done in this country, politically, is to get old people behind them.  Further health care reform doesn't now seem to promise much to old people, except spending cuts on them.  Given their limited time horizons, old people don't so much value system-wide improvements, which invariably take some while to pay off.

If Medicare had not been passed, might this country have instituted universal health care coverage sometime in the 1970s?

C July 21, 2009 at 7:09 am

If reform is the goal, it sure isn’t happening. If benefiting median-income voters at the expense of low- and high-income voters is the goal, “reform” is proceeding apace. Is there any incremental change proposed so far that doesn’t cozy to this motive? I would love to hear specifics.

Alan Gunn July 21, 2009 at 8:14 am

This is the best argument for Medicare that I’ve ever seen.

MrTuttle July 21, 2009 at 9:27 am

I love how the commenters over at EV are shocked – shocked! – that the health care industry will influence their beloved health care bill.

Steko July 21, 2009 at 9:50 am

“Yet the way to get things done in this country, politically, is to get old people behind them.”

False. That is in fact one way to do things but hardly the only way. Politics like much else rests on supply and demand and while seniors are an important part of it, they are not always the whole story as we saw with civil rights advances.

Your average working class joe didn’t cost a lot to insure back then so the demand for universal insurance was fairly low. But since insurers didn’t want to touch the senior population the demand for something that looks like Medicare was relatively high and would have increased every session until they passed something like medicare.

OTOH the demand for universal coverage is now high and increasing. The long term economic realities will demand real action sooner or later. Are we there yet? I think we may be. At any rate it will be interesting to watch and find out.

enoriverbend July 21, 2009 at 10:18 am

Jacob:

Yes, but when the Medicare cuts occur, and even fewer doctors (and nursing homes, etc.) accept Medicare patients, then even the most naive partisan of universal health care may extrapolate to other future government-run health care plans, and even — perhaps — start to suspect there is no free lunch.

john pertz July 21, 2009 at 10:24 am

I didnt think the reform proposal was that interesting anyways. I did get a good laugh reading the comments section over at Thoma’s blog though. I think if you told those people we were passing a reform bill in name only, they honestly wouldnt mind. If you want to talk about a DO SOMETHING bias, then that crowd over there certainly has it.

Gerald July 21, 2009 at 11:08 am
John Dewey July 21, 2009 at 11:32 am

tyler: “If Medicare had not been passed, might this country have instituted universal health care coverage sometime in the 1970s?”

If Medicare had not been implemented, it seems unlikely that medical costs would have risen as much as they have. In that case, would there even be a push for universal health care?

Assume medical care for seniors were not guaranteed. Would private corporations have invested so much developing drugs and treatments specifically for illness which disproportionately affects seniors? I doubt it.

Would emergency rooms be filled with bored seniors who view the trip to the doctor as a social event? (That was the opinion of my late brother-in-law, an ER physician for 30 years.)

Would the cost of senior health insurnace cause seniors and their children to push back at state legislative initiatives that imposed insurance mandates?

Ben R. July 21, 2009 at 12:00 pm

Since nothing else good is on the table, my hope is the Kucinich amendment, which allows states to more easily try to implement a single payer plan by granting a waiver to ERISA, survives the next committee votes. The states rights angle has garnered Republican support and the fact it means some progressive effects has gotten a lot of Democrats behind it.

But since it is logical, has bipartisan support, and is viciously opposed by insurance companies, I fully expect it to die horribly this week.

Anderson July 21, 2009 at 12:25 pm

In that case, would there even be a push for universal health care?

Since every other Western nation seems to have it, I daresay the answer is “yes.”

Krystal July 21, 2009 at 1:11 pm

The biggest waste in gov’t health care is the fraud. It is massive and if the gov’t would get honest auditors in they would save a large portion of money. The gov’t should not have created these programs in the first place. And this includes Social Security. They can’t run it honestly, it grows and expands costing taxpayers large amounts of money – we are forced to contribute and the money used for illegals. I watch here in NY all the time. Immigrants coming here and getting free education, food stamps and medical. Without having contributed a dime. In addition to demanding bilingual education at citizen taxpayers expenses. Medical costs are high due to gov’t meddling and massive fraud.

Steve M. July 21, 2009 at 1:34 pm

Prof. Cowen, you make Medicare sound like Bismark’s gambit in Prussia — offer a public pension system to take the wind out of the socialists’ sails. I would not be surprised to see, lurking in Medicare’s legislative history of in the public discussion surrounding it, some statement that conservatives may as well support it because some large-scale health reform is inevitable, and Medicare, as opposed to something different, will make it less likely that the United States adopts European-style health care in the future.

John Dewey July 21, 2009 at 2:24 pm

So, mulp, what evidence can you provide to show that “racists” deserted the Democratic Party? When exactly did this happen?

John Dewey July 21, 2009 at 2:33 pm

Ben R.: “single payer enthusiasts will argue that you’ll have five remaining small businesses when healthcare for their employees exceeds every other cost they have by five fold.”

Right. The only way single payer health care will ahve lower costs than Texas is through rationing. So Texas will play host to patients from single payer states who pay out of pocket rather than wait months for routine surgery.

Lord July 21, 2009 at 3:38 pm

“Given their limited time horizons, old people don’t so much value system-wide improvements, which invariably take some while to pay off.”

Dubious. Old people have the longest time horizons due to the length they have lived and their children and grandchildren. They know they aren’t getting out of it alive, but recognize their descendants will have to live with it.

William McGreevey July 21, 2009 at 5:08 pm

There is another path: Schip, Medicare, Medicaid, and other govt programs are expandable in various directions. Schip is flexible upwards to include persons under age 21 (could become 25?) in households with income < 2x (3x? 4x?) poverty line. Medicare could reach down the age structure from 65 to 62 (age of retirment for many) or even age 50. Medicaid could spread out, too.

If medical profession and pharma interests prevail now, creeping existing programs may offer a second-best solution.

Basho July 21, 2009 at 9:00 pm

Another tactical mistake was not just paying for Medicare out of general appropriations. The nominal payroll tax gives many seniors the illusion that they earned their benefits and that those on Medicare are not welfare recipients.

Mark D. July 22, 2009 at 1:39 am

Was Margaret Sanger alive at the time?

ken d July 22, 2009 at 9:14 am

Obama wants America to be a socialist nation. From health care, auto industry, financial markets & more to all be run by the govt. Look at the bill he introduced as a Senator to the United Nations. It calls for the American taxpayer to pay $845 billion to the U.N. to help institute a “global socialist society”, with the U.N running a one money global financial bank. Obama has now gone back as president (bypassing congress) which he can do as pres. & US Ambassador Rice simply signs it into law. Now congress must find the money by adding the tax on all financial transactions, so Americans can raise the $845 Billion.
Don’t believe me. Search Obama Global IRS
Wake up America!

David July 22, 2009 at 10:41 am

Isn’t the major problem the “stimulus” bill:

1) It negated the President’s claims of bipartisanship
2) It showed lack of concern for the deficit
3) It showed the administration could not accurately predict the results of its own legislation
4) to those with a libertarian bent it showed that the stimulus bill wasn’t really about stimulus suggesting that the health care bill isn’t really about health care

Rhonda July 22, 2009 at 10:48 am

Yes, David and how could they predict the results of this legislation when they did not even read the bill or any of the bills. Even Obama could not answer questions about the healthcare bill for sure because he even admitted he wasn’t familiar with “that part of the bill.” I saw this yesterday on the news and nearly fell out of my chair. This is the worst case of an incompetent administration I have ever seen. Even the average citizen knows how entirely ignorant it is to sign something and push for something you haven’t even read. The blind are leading the blind. How can the prez stand there in press conferences and look into the monitor and claim this is good for us when he has no idea what the dang thing even has in it?

Kimo AL Quds July 22, 2009 at 12:13 pm

Consider Darwin and his studies. The strongest survive and the weakest die off. It improves the genetic makeup of the remaining population, it ensures the survivability of the species. With uncontrolled population growth the basic needs that we depend upon, water food shelter become scarce. So universal health care is an attempt to further tax already taxed basic needs as the population lives longer utilizing existing resources. So are we going to start killing off the old people like in one of those moves from the early 70′s where no one made it past 30. Why is it the governments responsibility to provide medical coverage to people. That definitly is not in the constitution. It is not govt plce to provide for us from cradel to grave. it is our responsibility to take care of ourselves. When we fumble or there are problems, thats what savings are for. if it wipes us out financially then maybe it was time to say goodbye and accept fate and quit prolonging it. Govt owned health care is a joke and will cost everyone for what 18 million illegals and people who have put themselves and their families behind the 8 ball due to their desire for dope or booze. Our Education system offers all an opportunity to succeed and get ahead. People that dont want to take advantage of it why should we support them. They are non productive. I put myself through under grad and grad school by sacrificing life to do nothing but work and study. I didnt ask or get anything from anyone. Everyone is able to do what I did. Why should I WHO BUSTED MY ASS TO GET AHEAD WITHOUT ASSISTANCE HAVE TO NOW HELP THOSE WHO REALLY DONT WANT TO TRY. I SHOULDN’T AND NEITHER SHOULD ANYONE ELSE. THERE ARE ENOUGH PRIVATE OPTIONS AVAILABLE AND NOT ENOUGH DOCTORS. IT WILL TAKE A DECADE TO GET THE VOLUME OF DOCS THAT ARE NEDED. No govt needes to stick to its business and leave the private sector alone

John Dewey July 22, 2009 at 3:35 pm

Dixie L Trent: “The “old people” of this nation were the workers during and after WWII that SECURED a place in the future (a BETTER future, at that)for their children and grandchildren”

Just to be clear, I am extremely grateful for the contributions of the generations that came before me.

Dixie L Trent: “there wouldn’t be any “progressives” deciding what should and should not be done with us “old people”!!!

Though I will stand beside you and steadfastly oppose the progressives who would ruin our nation, I am not going to single them out for any blame about seniors’ loss of freedom. LBJ had the overwhelming support of the Greatest Generation in 1965, and used that support to push Medicare through Congress. When the Greatest Generation and their parents decided to turn senior health care over to their government, they forfeited the right to determine their own fate.

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