Explaining the obvious to Michelle Goldberg

In a diavlog last month on BloggingHeads.tv, Michelle Goldberg claims--with astonishing arrogance, condescension, and superficiality--that she doesn't understand why so many folks are opposed to the health care reform bills (32-second clip):

Some responses to her questions & assertions.

ITEM #1. "Do [Townhall protesters] think the current system is acceptable?"

RESPONSE: No. The people who say at town halls that they are "satisfied" with their current health care plans are probably either (1) healthy younger folks who don't have to deal much with the current system and/or fear that they will have to shoulder more of the burden by subsidizing older folks, or (2) they are retired or soon-to-be-retired folks who fear losing elements of their existing Medicare coverage. Both of these fears are warranted, and people tend to fear losing something they already have more than they relish getting new benefits that they don't already have.

ITEM #2. "The worst part is the paperwork"

RESPONSE: Duh. Most people who have dealt with the system agree that the paperwork is awful. I'm just not confident that reform bills proposed by Democrats will reduce paperwork. Expanding government programs hasn't been a good formula for that in the past.

ITEM #3 "There's lots of misguided love for insurance companies among reform opponents."

RESPONSE: Matt Welch--he's amazingly polite to her--does a terrific job of dismantling this assertion, which is just not true. (Clip below, length 1:58, is different from one above):

ITEM #4. "Jim Wilson [yada yada] Glenn Beck. You can't argue 'death panels' and you can't argue 'totalitarianism' "

RESPONSE: If you revisit Aristotle's Rhetoric--the part on style in Book 3--you'll see that use of metaphors is one of the most powerful and effective methods of persuasion and argument. Opponents of health care reform use the terms "death panel" and "totalitarianism" as metaphors for rationing and encroaching government. Yes, they are gross exaggerations. But these metaphors (especially the death panel one) have touched sensitive nerves in the public. So yes, you actually CAN argue death panels and totalitarianism. And responses to these arguments (from Pelosi et al.) have been weak and unconvincing.

ITEM #5. "Just give me something like the French health care system."

RESPONSE: I'm no expert on the French health care system, but some quick Googling indicates that the French system does not suffer from problems the U.S. has with malpractice insurance, defensive care, and the tort system. This means that one of the key steps for getting us to something like the French system is tort reform. To my knowledge, the current Senate bill does little or nothing to deal with this issue.

ITEM #6. The reasons for opposition are "more psychological than economic".

RESPONSE: This was the most condescending of all her statements. If Michelle had looked to some of the more thoughtful folks presenting alternatives to the reform bills she would have found plenty of economic reasons to criticize the reform bills. I can think of three examples:

I. Check out David Goldhill's piece in the Atlantic Magazine How American Health Care Killed My Father. His suggestions:

• Move away from comprehensive health care as the single model for finance health care.
• Put the consumer, not the government at the center of the system.
• Give government the primary task of bringing greater transparency and competition to the health care industry and directly subsidizing those who can't afford care.
• Fund routine care out-of-pocket (not covered by insurance) so the people who care most about cost--consumers--are in their proper, primary role of trading off price, quality and value.
• Fund massive, unpredictable expenses with insurance.
  
• Replace our current web of employer- and government-based insurance with a single [mandatory] program of catastrophic insurance open to all Americans. . . with fixed premiums based solely on age. . . a single national pool, without underwriting for specific risk factors [that] would ultimately replace Medicare, Medicaid and private insurance. [With a high threshold for defining "catastrophic" at approximately $50,000 or more.] Limit insurance payouts in any year to the amount of available premiums.
• Over time, shift over to funding all non-catastrophic care from an improved, mandatory version of HSAs.
• Fund intermediate level expenses (e.g. appendectomies) just as we do things like new cars: with credit. But allow people to borrow against future deposits into their HSA.

The bottom line for this approach:

Imagine how things might change if more people were buying their health care the way they buy anything else. I’m certain that all the obfuscation over prices would vanish pretty quickly, and that we’d see an end to unreadable bills. And that physicians, who spend an enormous amount of time on insurance-related paperwork, would have more time for patients. . . .

It will do a better job than our current system of controlling prices, allocating resources, expanding access, and safeguarding quality. And it will do a better job than a more government-driven approach of harnessing medicine’s dynamism to develop and spread the new knowledge, technologies, and techniques that improve the quality of life. We won’t be perfect consumers, but we’re more likely than large bureaucracies to encourage better medicine over time.

II. Dr. Peter Weiss of Medically Incorrect makes many of the same points in this video. Dr. Weiss's prescription for reform includes the following items:

1. Increase competition among insurance companies by allowing them to compete across state lines.
2. Allow people to buy health insurance through affinity groups like AAA or Costco without regard to pre-existing conditions (just as employees get insurance through large employers).
3. For employees who lose their jobs, allow them to buy COBRA insurance at the employer was paying (not the double or triple rate that COBRA charges).
4. Strive for major illness insurance. Insurance is meant for catastrophes, not for everyday expense. Make people pay out of their own pocket for small predictable expense like office visits and PAP smears.
5. Have a system where consumer must take ownership of expenses (because cost is the main culprit, not access or quality).

III. Then, there's Congressman/Doctor Tom Price's alternative bill titled Empower Patients First (H.R. 3400). It suggests:

• Fix the unfairness in the tax treatment of health insurance by extending a tax credit or deduction to those without employer-sponsored insurance;
• Use automatic enrollment, with a right to “opt out” of health insurance coverage, and promote defined-contributions for employer plans, instead of using government coercion and mandates, to expand coverage;
• Establish health plan portals in the states so that patients can own and control their own health insurance;
• Offer low-income Americans the option of a voucher to purchase private coverage; and
• Give states incentives to experiment with how best to cover high cost individuals.

The full clip on health care is here (length 10:52):