My apologies to the amiable, the adversarial, and the amiably adversarial, all alike, for my delay in acknowledging ShrinkWrapped’s healthcare reform Wrap Up and in offering some sought after replies. Unfortunately, this generic academic was off engaging the real world of which he is otherwise so woefully ignorant. Generic academic, doubling as generic liberal, chooses to inform his kindly medicinal presence (Zounds, man, but my head, it doth hurt!) that regarding his ignorance of economics, particularly the real-world variety, GA has managed three businesses in his lifetime, two of them to success (it being the failures, or course, that truly educate). But this being only Shrink and Scribe’s second date, there is still so much to learn about one another. As to GA’s knowledge of medicine, well, he will presume to remind the good practitioner of physic that just last month GA was in an emergency room!

To clean up loose ends, commenter Neil offered a clarification that did its job, for which I thank him, and focused his point:

In studies of survival rates in cases of critical care (the “really get sick” situation) such as some types of cancer, U.S. outcomes are head and shoulders above other countries with more communal health care systems. Unfortunately, these are the sorts of capital-intensive interventions that are likely to be limited by any health care spending bureaucracy.

This raises an issue on a matter of equity that often seems to concern conservatives. They, including if I understand him, SW, fear a diminishment of high-end care in the drive to provide equity in what they would consider middling care. There is resistance to subsidizing others, perhaps at all, but more particularly if it sacrifices the possibility, in principle, of any individual receiving the best possible care if needed. However, viewed conversely, in Neil’s formulation above, are not many individuals systematically required to receive lesser care – and no insurance protection (our current condition) – so that, in reality, only some individuals may have access to these capital-intensive interventions? Why should these individuals assent to such a system?

I applaud Neil for being inventive in his HSA idea. As the one-time business man and pragmatist I always am, I am always open to inventiveness, which I never oppose as a matter of ideology. It would be interesting to see the numbers crunched on the idea.  However, when Neil writes

The simplest thing would be to expand the Health Savings Account program to allow greater yearly tax-advantaged individual contributions to the HSA account

I confess to having the same reaction I always do when conservatives propose as a solution to economic disadvantage – in this matter, the inability to afford insurance premiums – the later tax advantage of contributions to some sort of private account. Who, I wonder, is not living in the real world?

When he concludes that the winning outcome of his plan is that

The right gets increased freedom and responsibility, the left gets an increased safety net and higher taxes.

I applaud as well his humor in suggesting that for the left higher taxes are not simply a means but a very end of social policy. We’ll pursue a booking for him at the Laugh Factory. Although, on the matter of humor, Neil supportively cites commenter Naomi (permission granted to breathe) citing the honorable John Ensign on the subtraction of auto and gun deaths from U.S. healthcare outcomes, when I would wager a bet (note what follows) that Naomi’s tongue was planted nowhere but in cheek.

MaxedOutMama disagrees with me on the nature of insurance as gambling, by citing its social usefulness and frequent economic efficiencies. However, I assented to these characteristics at the start. What I did was challenge whether every insurable circumstance should, as a matter of policy, be insured. The definition of “gamble” in the American Heritage Dictionary is

1. To bet on an uncertain outcome, as of a contest.
2. To play a game of chance for stakes.
3. To take a risk in the hope of gaining an advantage or a benefit.
4. To engage in reckless or hazardous behavior: You are gambling with your health by continuing to smoke.

MOM seems, perhaps, to focus her position on the fourth definition, but the first three apply to almost every kind of insurance as much as to gambling, and they apply to the insurer as well as to the insured, though it is the case, as another commenter offered, that for the gambling to sustain itself, the house must always win over the full spread of chances.

Additionally, MOM seeks to know

whether you would be wiling to accept a Medicare payroll tax of between 17.5% to 20% for the sake of establishing a true single payer system? I realize there would be caveats in your mind either way – you’d want to know more about the proposal before signing on, as would I.

But I would really like to know whether that is acceptable at all to you. So far my surveys on this point have not provided any support for the idea that the US population is willing to accept a public health care system. I asked on DU a number of times, and most people rejected it.

With all the caveats MOM anticipates, and believing the essential intent of her question to be one of my willingness to pay more myself in order to achieve greater equity in healthcare access, I have two answers. The first answer is that, based on the change in my own insurance to which I referred in The Open Mind II: Riposte, I am already about to pay more for the same, or the same for less, depending on how one considers it, without achieving any greater equity in access. The second answer is “Yes.”

Beyond that I am as duly impressed as is SW by MOM’s immersion in the numbers and particulars of the health matrix – indeed, the numbers in many areas, as I discovered by checking out her blog. I am impressed by her undoctrinaire and pragmatic assertion of the health need to cover the health needs of those who are in the country illegally but whose presence is accepted. I do need to point out – in the context of the sausage factory of contention that produces legislation – that it was only in a vain attempt to court Republican support, and in order to prevent further public conservative eruption, that Obama so vocally excluded such coverage from any plan he would accept. Nonetheless, I agree with SW that MOM should be eyeing a congressional seat. I might even, with all proper prophylactic protection against the nomenclature, do a Lieberman if she did.

Finally, to give SW the truly last word, I think it is essential to his argument that all currently proposed reforms will stifle innovation, diminishing both the high end of care and the ever improving general level of care that will, as a matter of economy, trickle down from it. He states in his Wrap Up.

I would like everyone to have access to the finest medical care our nation has to offer.  Unfortunately we cannot afford to make such care available.  As Neil notes:

The next best option is to create a system which allows “good enough” care for the maximum number of people while also enabling the innovation that will continually make such care cheaper and better over time.  The current iterations of Obamacare will do neither.

When you argue for universality rather than letting market forces increase the supply, you are implicitly saying that it is better that we all make do with less, rather than let anyone have more. People will die from this. Almost certainly more people than will be saved by universality.

AJA