View From Down Under

Speaking of chickens, Nevada Republican Senate candidate Sue Lowden is (deservedly) taking a lot of flak over her comments about using chickens as payment for doctor visits.  Here is one of my favorites, a website that conveniently calculates how many chickens you should bring the doctor for specific procedures (24 for an annual check up, 2,166 chickens for a normal birth).

Ms Lowden has provided a great source of material for comedians, but the real issue is the belief among many that the free market can provide appropriate health care solutions.

A pure free market health care system would, in my opinion, result in lower cost of health care – probably much lower.  The trade off is that it would exclude some care from those who could not afford it – or chose to spend their money on other things.

What Sue Lowden is really saying, is that Americans should only get the health care they can afford.  If you have chicken pox and a chicken, and you find a doctor (and pharmacist) willing to trade the chicken for the zovirax, no problem.  But if you have chicken pox and no chicken, well that’s poor planning on your part.  If you get cancer, or need dialysis …

Americans, to their credit, generally reject this kind of health care system.  They believe health care should not be only for the wealthy.  So there are public hospitals and Medicaid and other systems in place so that if someone shows up at a hospital with a broken leg, or a gunshot wound, or failing kidney, they receive treatment regardless of their wealth or insurance.  Health care has become a common good, like roads, where people cannot be excluded from its use.

Except, apparently, to Republicans like Sue Lowden.

The view from down under is that the US needs to decide whether health care is a common good or a private good.  The current system treats health care as a common good in usage but a private good in payment.  That is not only the root of its problems, but is ultimately unsustainable.

President Obama is finally starting to show some much needed leadership on health care reform, inviting Democratic and Republican leaders to a health care summit, and promising to publish its own version of health care legislation in advance.  Obama challenged Republicans to do the same.

Despite the rhetoric from the White House, there is little hope that a bipartisan health care reform package will emerge from the process.

The last time the Republicans put forth their health care plan it was weak, marginal, and provided little other than tort reform.  It appeared to be a hasty answer to the charge that they were just being obstructive, and fortunately the plan sank into oblivion quite quickly.

Nonetheless, Republicans have deep differences with Democrats on what health reform means.  The Republican position on health care appears to be something like this:  we should let the ‘free market’ provide health care; but don’t cut Medicare (even though several Republican proposals do exactly that); and don’t remove the tax break for employee funded insurance (which would at least attempt to create a free market); and do allow interstate insurance programs (while continuing to allow wildly different state based standards); and ‘enhance’ the free market with a combination of vouchers, savings incentives, and tax credits.

That they have been allowed to get away with this as a ‘policy’ is bemusing, to say the least.

To Democrats, health care reform means making sure all Americans, or as many as possible, have health insurance.  The rest of the Senate bill is basically trying to pay for this, with a number of pilot programs that will probably reduce costs over time but whose ultimate impact is unknown.

When you consider that most Republican voters are not opposed to expanding insurance cover (in fact it was part of John McCain’s campaign platform) yet Republican leaders passionately oppose the Senate bill, it becomes clear that what the right wing really wants is for the President to fail so they can replace him with Sarah Palin.

Let’s be clear, neither side is really proposing health care reform, and despite the rhetoric that this is an historic ideological battle, the reality is that both sides are talking about fairly minor changes to an insurance based system supplemented by government health care for the elderly and poor.

With his summit, Obama is making one last effort at appearing to be bipartisan before pushing through a health care bill.  He cannot afford to head into the next election with no health care bill passed, but also doesn’t want to be painted as part of an arrogant left wing that can’t negotiate with Republicans.

The view from down under is that it is past time for Obama to stop delegating to Congress, and time to provide clear leadership.  The promise to publish the White House plan, which will undoubtedly have support of Democratic congressional leaders, is a good first step in that it moves the plan from being a Pelosi plan or a Reid plan to being an Obama plan.

If the Republicans offer to negotiate for a better bill, the Democrats will have won the public debate and will have a comprehensive health care bill passed soon.  Of course, Republicans know this, and because of their past rhetoric their logical course of action is to continue to obfuscate, try to scare people (death panels part deux?) and do their best to block all legislation.

Which, ironically, will make the final bill much more of a left wing reform bill and therefore more likely to have real impact on both the cost and availability of health care in America.