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Yesterday morning I amused myself twittering about how the House Republicans would prefer the sick to die homeless in tents. At about the same time, a crowing blast-emailed press release landed in my inbox, cheering the Republicans. It was from the Heartland Institute, a Chicago-based free market think tank funded by corporations and wealthy individuals including one of the Koch brothers. Heartland has staked free market positions on all matters, including claiming global warming and secondhand smoke cancer are based on junk science.

I decided to respond to the email, and Heartland's communications director, Jim Lakely, author of the press release, kindly replied. By the end of the day, we had produced a rather civil conversation between a supporter of socialized medicine (yours truly) and Jim and his team of free market health care gurus.

As part of my effort to be less snarky, and more of a listener, as per our president's call for civility, I promised Jim that I would post his replies along with my challenges to him and his guys.

I did give myself the last word, though, apologies, Jim. You know what they say about writers.

From the press release:

"In voting to repeal Obamacare's government takeover of health care today, the House Republicans voted as well to repeal trillions in future Medicare cuts that would leave America's seniors unable to get essential health care when they most need it. Current law still provides for this effective early death sentence for millions. This unreported story is documented in official U.S. government reports. Most Democrats have no idea what they have done in enacting Obamacare."

From Nina Burleigh:

Hello,
Correction: It's not "Obamacare" as much as Frank Luntz would prefer us to use that name along with you people, it's health care for uninsured Americans who are going bankrupt trying to stay healthy.
Which insurance company pays your salary, "Heartland"?
All best,
Nina Burleigh

From Jim Lakely:

Thanks for your comments. The Heartland Institute is a 27-year-old think tank that focuses on free-market solutions to social and economic problems. Oh, and an insurance company does not pay my salary, though we do have a health plan at Heartland.

Besides, what's wrong with using the term "Obamacare," especially if the president is proud of his signature legislative achievement? I'd think the president and his supporters would want to link the law to him as closely as possible to ensure he gets the credit he is due -- just like there are "Roth IRAs" and "Fulbright Scholarships."

Thanks, again, for your reply. I hope you might find our perspectives useful to your news and features coverage from time to time.


Jim Lakely

Communications Director

The Heartland Institute

From Nina Burleigh:

Thanks Jim!
I do find your missives edifying, thanks. Keep them coming, although I may not always reply.
And I don't think "Obamacare" is accurate, because many people in Congress worked on the plan as well, and everybody agrees this country is long overdue to have some kind of social net for the sick. It's simply barbaric to make people lose their houses to pay for health care, you must agree with that.
All best
Nina

From Jim Lakely:

We'll obviously disagree on whether or not there is a social net for the sick. (There is for the poor, for sure.) And I'd argue that the instances where people lose their homes to pay for health care are rare enough that the entire health care system in this country did not need to be managed from Washington to "fix" it.

If real market forces (as opposed to limited and managed forces) were unleashed upon America's health care system, that would drive prices down and make it more affordable for everyone.

Best,

Jim Lakely

From Nina Burleigh:

I don't know about that Jim, because we lived in France and Italy over the last decade, where as you know, they have socialized (yikes!) medicine. And we were totally stunned at how cheap and good the care is in France. I had a kid there, 5 days in hospital and it still cost a fraction of what it cost to have our first baby here in nyc.

And in Italy, my husband walked in with some horrible strep thing, to a hospital, was fixed with free medicine and then sent to a specialist a few days later who diagnosed some allergy he had that no one here ever noticed... and he did not get charged a centime.

I know they are having economic problems in Europe, and this may not last forever, and people don't like paying high taxes but, their lives are SO MUCH easier than ours. The Europeans will I think, never give up their medical system now, and frankly, if something bad happens to me, and if I don't have insurance, I would get a ticket on Air France.

I love my country and I think people here deserve more. Americans do not understand the benefits of paying a few dollars more to the government for a better health care system. And part of the reason for that is places like Heartland, where you don't even give credence to the benefits of these other systems. The "socialism" bugaboo is ridiculous. Some governments can do some things better than private sector. Moderation in all things, including ideology!

Cheers

P.S. I hope you will be able to explain to me how the free market unleashed on health care will drive down prices.

Sick and dying people will pay anything to get better and stay alive, therefore the standard economic supply and demand calculation doesn't apply. Demand for health and life will always outpace supply of healthy life. People are always sick and dying. For them and their loved ones, there is no price too high for health and life. And the market will find a way to get that price, because that is the nature of the market.

Correct me.

From Jim Lakely:

Nina,

I am not a health care expert for The Heartland Institute, though I'm well-versed on the free-market perspective of this topic. I bounced some of your questions off those who are health care policy experts at Heartland. Their contributions are incorporated below. So, with apologies for the length of this email, here we go...

The standard we should be talking about is the one put forth by Obamacare's supporters -- that government management of America's health care system will increase coverage, as well as the use of medical services, but decrease costs. So far, it seems that this promise is upheld by just that: mere promises -- as well as the kind of garbage in/garbage out accounting we get in Washington.

Now for some breakdown of your points:

The health care you and your family received in Europe was not "free." If you paid taxes in either Italy or France, you were indeed "charged a centime" for your health care -- several, in fact, and likely more than you would have paid for comparable care in a free-market system.

A quick look reveals that pharmaceutical companies congregate in the freest economy they can possibly find -- mostly the United States, with the United Kingdom, Japan and Switzerland distant seconds. Only Sanofi-Aventis puts in an appearance for France in the top ranks. Italy is nowhere to be found.

Socialized health care overseas, in short, is nearly always in a position of simply purchasing and redistributing that which is developed elsewhere.

You note that there are "economic problems" in nations with nationalized health care systems, and you're quite right. Those problems aren't ancillary to the health care systems there. To the contrary, they're partially caused by those systems. ... And, surely, the economic problems of Europe won't last forever. But they will end when those countries begin to dismantle the unsustainable welfare states they have erected. As Margaret Thatcher once quipped, eventually you run out of other people's money.

The crisis that exists in America is not actually about the quality of health care. In nearly every way, the health care system of the United States leads the world. Indeed, in comparison to Britain, for example. The UK's cancer survival rates are near the bottom for all of Europe (according to Lancet Oncology). Women who contract breast cancer there die at nearly double the rate of in the U.S. Fewer than one out of five American men who get prostate cancer die of it, but in Britain it kills 57 percent of men who contract it

The illusion of a third-party-payer system -- such as in your experience in Europe -- hides the true costs of health care from people, removing them from the decision making process, and preventing them from making informed choices about their health care.

What The Heartland Institute wants is ... a system where people can choose for themselves what care they wish to receive, to know how much care costs, to make their own priorities for the care they need (do you want surgery or rehab?) -- and then to direct that care in consultation with their doctor.
Through price controls, regulations, burdensome requirements, and the force of public relations, President Obama and his administration plan to keep costs down by sheer force of will (or, in the case of HHS Secretary Kathleen Sebelius, outright threats). This will inevitably lead to cost-based rationing -- not the kind where you decide, on your own behalf, what to spend your money on, but the kind where others decide what care is even available for you to purchase.

In such a situation, it is inevitable that the sick and the elderly become viewed as drags not just on families but on the whole of society as taxpayers fund their care. This is a recipe for exactly the kind of situation that has resulted in the United Kingdom, where the Economist Intelligence Unit recently found that the National Health Service ranks at the top in one category: quality of death. Why? Not because they cure people, but because they assign the most painkillers.

Warm regards,

Jim Lakely

From Nina Burleigh:

That's a thorough answer, and so, now I may have to respond to some of it. First off, using Britain as a model, Britain! Where as you pointed out, Thatcherism privatized everything and took the stuffing out of programs. Have you ever taken a train from France to the "chunnel" and noticed what happens to the track as soon as you hit England? The privatization "improvement" notion is an international joke over there. Some people saved a bit of money so that everyone can suffer on stinted-on public trains service!
Back to socialized health. Why not discuss France? Where the system is acknowledged better and where people live longer than we do?
As for the tax rate, Americans are already taxed like the French. Our money just goes somewhere else, defense and so on, it is about priorities.
(I might add, my for-profit health insurance company doesn't allow me to choose anything. Or rather, it allows me to choose to do nothing, or choose to go to one of the dwindling number of doctors on its plan. I wager I have no wider array of doctors to choose from than the British. And I cannot imagine the government could come up with more bureaucratic red tape than the insurance companies already have.)

UPDATE: Read The Heartland Institute's response here.