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Wednesday, July 8, 2009

Hunter vs. Heidelberger: The Madison Debate on Health Insurance Reform

Madison Daily Leader publisher Jon Hunter spouted some nonsense about health care and government control on his editorial page last week. I promised Sibby I would set our man Hunter straight this week. Mr. Hunter does me the favor of publishing the following letter in last night's MDL. For those of you with paper allergies and Madison ex-pats everywhere, I reprint that letter below (with hyperlinks!):

To the Editor, Madison Daily Leader:

I have observed the Madison Daily Leader's continuing campaign against sensible, affordable taxpayer-funded health care with alternating amusement and annoyance. MDL's latest fear-mongering about government involvement in health care reform (see the July 2 editorial) rouses me to write.

Last Thursday's editorial frets about the provision of "free" health care for the uninsured. The editorial wrongly assumes that government health insurance is a handout. Actually, many participants in a public health insurance plan would pay their fair share through taxes. There are plenty of middle-class taxpayers who lack health coverage now either because they cannot afford the exorbitant premiums or because our vaunted for-profit insurance system won't cover them due to previous illnesses or injuries that are no fault of their own.

Thursday's editorial waves the usual red flag of terror at the prospect of government making your health care decisions. Let government pay for health care, and next thing you know, government will be telling you what doctor to see, what pills to take, and so on... so goes the usual refrain. This false thinking ignores the current reality of the for-profit insurance system, where private bureaucrats and insurance company lawyers dictate which doctors you can see and which procedures will be covered, all while devising loopholes to deny you the coverage you thought you were paying for. MDL's argument also ignores the fact that the government is us: we can exert much more control as democratic participants over a public plan run by us and our elected officials than we can exert over any private insurance company whose primary goal is to generate profit, not serve the public good.

Thursday's editorial then veers off on a tangent about the $1.1 billion portion of February's stimulus package that supports research to compare treatments for various medical problems and identify the most effective treatments. The editorial constructs a paternalist straw-man, claiming that a public program seeking to lower costs and provide better care just shows government mistrust of the common man's wisdom.

Now the stimulus package is completely separate legislation from the health care reform Congress is currently working on. But since the editorial brought it up, I'll note that nothing in the stimulus package or, likely, any health care reform Congress passes this year will stop Jon Hunter or me or anyone else from reading all we want about "prostate cancer, back pain, and hearing loss." Of course, when I limp into the hospital with some malady, the last thing I want to hear from Dr. Beecher is, "O.K., Cory, you're smart: read these fifty medical textbooks, study the different treatments, and then tell us which one you want." I really would rather the experts—medical researchers, supported by stimulus dollars, providing the evidence that doctors themselves say they need—save me time and money and tell me what treatment is best.

But nothing in that odd diversion in Thursday's editorial addresses the fundamental advantage of public health insurance. The whole idea of insurance is that we pool our resources with our neighbors to help each other out when misfortune strikes. The best insurance has the biggest pool. Why not create the biggest pool possible: 300 million Americans contributing tax dollars to one universal non-profit insurance plan?

Congress will not, alas, go that far. President Obama himself has said a single-payer option is not on the table. The best we'll get is a public plan option (keyword: option, meaning no one is required to join, no one has to give up the insurance they have). New numbers from the Congressional Budget Office find that a public option would cut the 10-year cost of health coverage reform from a trillion-plus to $400 billion. $40 billion a year -- not a bad price tag for near universal coverage. A public plan would also create price competition that is currently mostly non-existent in our alleged "free" market system.

Hmm: saving money, enhancing competition, and taking better care of our neighbors. Those sound like good American goals to me. Perhaps MDL will rediscover those values before its next discussion of health coverage reform.

Cory Allen Heidelberger
Lake Herman, SD
[published in the Madison Daily Leader print edition, 2009.07.07]

If you think the arguments here in Madison are fun, just wait 'til you hear the debates Congress will have this month... just in time for the arrival of stealth wonk Senator Al Franken (who, by the way, believes single-payer is the most effective way to cut administrative costs and provide universal coverage—yes! Al! Make the push!).


  1. With the latest announcement of hospitals agreeing to contribute $155 billion, where are the costs going to be shifted for the $155 billion? Doesn't anyone get it? It is going to be shifted somewhere. In Utah, studies conducted by http://www.BenefitsManager.net revealed that cost shifting already exists in ER. Why do you think aspirins cost $10? Someone is going to pay whether it be a reduction in quality service or higher charges for those with insurance policies. Someone gets dropped off at the ER doorstops full of bullet holes with no insurance….next person that comes in with a insurance cared has costs shifted to them. I see it daily when advising hospitals through billing issues with http://www.UtahInsuranceExchange.info which is our state’s steps towards health care reform. Sure, the government is proposing subsidy…so how much will that affect the tax payer? Again, why are we not talking about TORT REFORM to push liability insurance premiums down that absorb as much as 15% in expenses with medical providers?? Take 15% off total medical expenditures in US and you will see savings in the trillions.

  2. "why are we not talking about tort reform"?

    Because, Mike, tort reform hasn't lowered health care costs in a single state, states without caps have more doctors than states that impose tort limits, medical malpractice costs constitute less than 2% of health care spending (where's the link for your alleged 15%?), malpractice lawsuits and payments have declined, and there's no empirical evidence that increased malpractice premiums lead to increased "defensive medicine" or that tort reform stops physicians from ordering excessive tests and procedures.


  3. Senator Franken, how do you intend to have us pay for universal health care? I must have that information in detail before I can get behind your plan (or any other).

  4. E-mail Senator Franken! He's probably pretty busy moving office furniture and finding the bathrooms in the Capitol, but he just might have an answer!


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