Wednesday, July 5, 2017

Health care critique

This blog entry will endeavor a critique of the health care positions of the Senate candidates. Those positions, per their websites, are set out at Candidates on health care.

It is the job of the Alabama news media to critique the positions of the candidates. I wish to post links here to critiquing that the news media does. Please call my attention to the same so that I can do that.

I have been posting my views about health care, which can be accessed starting at Health care and following the links there.

Pending hearing from the Alabama news media, I will do my own critique here. The critique will be in summary form (in some order of priority of importance in my mind).

FIRST, I contend that any candidate who does not ask, and try to answer, the question of "why does the United States spend so much more on health care than any other country?" should be judged as not meritorious to represent Alabama voters in the United States Senate. (For further discussion here, go to the blog entry Calhoun County.)

SECOND, after the candidates answer the FIRST question, the candidates need to revisit their stated positions on health care and decide whether they want to revise the same or not.

THIRD, after the candidates answer the FIRST question, and revise or do not revise their positions on health care, all of the same need evaluating and critiquing.

FOURTH, the case for the Republican health care bills suffers from great indefiniteness about (i) how much less money will be spent on health care (compared to the present). (ii) how much less health care, including people losing coverage, will result from less money being spent on health care, and (iii) how much savings can be achieved from purported greater efficiency in the delivery of health care. This indefiniteness is such that any predictions about the same could be off by 50% to 90% or more. A couple of particulars are deserving mention.
A. All predictions about the future suffer from uncertainty. If proponents of the Republican bills want to disregard CBO scoring because CBO scoring has been off in the past, they need to put forth their own scoring method and a persuasive argument why such scoring method is superior to the CBO scoring method (and hence CBO ought to change from its method of scoring to the method put forth by the proponents of the Republican bills). If that is not done, the predictions made by the Republicans should be considered more dubious than what the CBO says. 
B. The Republicans thus far are making only bald assertions about savings from greater efficiency in the delivery of health care, and there could be almost zero efficiency savings. Without much more buttressing, such assertions about efficiency should carry almost no weight. Take for example the contention that states can administer Medicaid more efficiently if Medicaid is turned over to the states. A contention like that needs to be backed up, such as by state Medicaid administrators giving detailed descriptions of current waste or inefficiencies and what they could and would do to lessen the same if control was turned over to the states.
C. The most strenuous contention the Republicans make is that their bills will lower premiums and deductibles, particularly as a result of competition in increasing plan choices, including allowing plans to be sold across state lines. No one doubts that it is possible to lower premiums and deductibles for some people, but the Republicans don't face up that, if premiums and deductibles go down for some, they will go up for others. Also, total premiums and deductibles can be lowered if total health care spending is reduced, such as by cutting back on "essential health benefits" or allowing life time caps. Here, the Republicans don't face up to the price of lower premiums and deductibles being less health care services. Basically, the Republicans want to contend they will lower premiums and lower deductibles for a reason not dependent on (i) lowering premiums for some and increasing them for others, or (ii) lessening the total health care that is provided, but from a third element of the effect of competition in free markets. This is a chimera as regards health care through insurance. I have set this out in the blog entry Calhoun County. Rand Paul has said more or less the same thing. See Health care symposium. I contend the Republicans are peddling snake oil here.
FIFTH: Tort reform related to health care, and reduction of drug prices, are ways to reduce health care spending. Candidates need to say whether they advocate tort reform related to health care, and whether they think voters should have any confidence that Congress is capable of passing such tort reform. Reducing drug prices would essentially be by means of governmental control, such as Medicare being allowed to negotiate drug prices. Reducing drug prices will tend to lessen the development of new drugs. Candidates need to state their views one way or the other about reducing drug prices via government control.

Edit 7/6
Questions for candidates at tonight's Christian Citizen Task Force bipartisan U.S. Senate Forum  at The Rock Family Worship Center at 2300 Memorial Pkwy SW in Huntsville, Alabama:

1. Are you aware of how much more the United States spends on health care than any other country? Why does the United States spend so much more on health care than any other country? How critical is it that health care reform endeavor to bring down such greater spending? What do you think health care reform should provide for to bring down such greater spending?

2. Rand Paul says markets and competition do not work for health care provided through insurance. Do you agree with Rand Paul? If you don't agree, explain why you think Rand Paul is wrong.

3. If you favor repealing Obamacare, are you in favor of simply returning to the situation before Obamacare with no new enactment? If you think there should be a new law, should the voters judge their Congress as doing its job properly or as doing its job poorly for the voters if Congress cannot agree on a new law before Obamacare is repealed and creates huge uncertainty for the country? If that is poor performance by Congress, do you think Congress needs to do some soul searching about the explanation for such poor performance and make recommendations to the voters for the improvement of its performance?

4. For Roy Moore: You say you are against socialized medicine. Do you consider Medicare socialized medicine? If so, what would you want done about Medicare?

5. Do you favor reducing drug prices via government control, such as empowering Medicare to negotiate drug prices?

Edit 7/14 Terry Lathan
I offer the below tweet interchange with Terry Lathan, the Chairman of ALGOP, as supplementation of the above critique:

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