On Health Reform, George F. Will Just Threw a Spitball

One could say of George Will what James Russell Lowell wrote of Emerson: "His eye for a fine, telling phrase that will carry true is like that of a backwoodsman for a rifle." Which is to say, the guy can write. But anyone who reads Will's latest screed on health reform with a critical eye might also be inclined to quote Lowell's observation about an Emerson lecture:

"It was as if, after vainly trying to get his paragraphs into sequence and order, he had at last tried the desperate expedient of shuffling them."

Indeed. Will's column is a mashup of disparate declamations. As is often his style, he offers quotes that are very enjoyable but only loosely related to the topic at hand. We also see the selective use of survey information and some standard-issue conservative lamentation that we have yet to unleash the power of the free market to fix health reform. (Will someone please provide some working examples of a "health care free market"?)

And baseball references, of course. If it's a George Will piece there has to be a baseball reference.

To the extent that the piece has a structure, it is built around a statement from Elizabeth (Betsy) McCaughey saying that the percentage of family income Americans spend on healthcare is essentially no greater now that it was in 1960. No supporting information or source material is offered for Ms. McCaughey's statement. Given her well-documented history of making false statements about health-related issues, it is sadly impossible to take this statement at face value. (See here for more information. Mickey Kaus, himself no liberal, wrote that "she completely distorted the debate on the biggest public policy issue of 1994.")

What's more, the point isn't all that relevant even if it's true. Medical conditions account for two-thirds of American bankruptcies today. Perhaps people died from lack of medical care at a greater rate in 1960, which limited their out-of-pocket expenditure. Or maybe people suffered just as much health-related bankruptcy back then as they do now.

Will goes on to say: "... (A)s societies become richer, they spend more on health care -- and symphonies, universities, museums, etc." This statement would be hard to substantiate, especially in the prosperous nations of Western Europe that spend far less on health care than we do. And Americans struggling to stay solvent while paying for needed care might rightfully take offense at the Marie Antoinette-ish undertone of the sentence. It's as if medical treatment were a whimsical indulgence of the prosperous, like attending the gala premiere of a new opera season.

"It is also because health care is increasingly competent," Will adds. But competent for whom? Isn't the ability to spend money on what works an essential aspect of competence? Yet conservatives continue to oppose studies that demonstrate what works and what doesn't. We spend far more on health care than other industrialized nations and yet have poorer results, as measured by public health statistics. That does not meet any commonly-held definition of "competence."

And why compare us to the US circa 1960, anyway? In those pre-Medicare days older Americans and their families often went broke trying to meet basic medical needs. That could certainly account for the relative lack of change in those cost percentages over the past 50 years. It would make more sense to compare us to those countries that have a rational health system today - but that's not a comparison Mr. Will appears ready to make.

Ms. McCaughey, for her part, is now hard at work trying to undermine health reform by playing what can be described as a "six degrees of policy separation" game. In this piece, for example, she takes the Kennedy bill's "medical home" provision and suggests that it vaguely resembles "the unpopular controls HMOs imposed two decades ago" penalizing doctors for providing or authorizing care that was not approved by the plan. That provision is not present in the Kennedy bill nor, upon careful reading, does she claim that it is. But it looks like something that looks like something that looks like that provision ... or so she says, leading to guilt-by-inferential-association.

I don't mind a good healthy challenge in the marketplace of ideas. It would be valuable and even enjoyable to engage in a pickup game with our conservative colleagues over the merits of health reform. But George Will is throwing spitballs, layering extraneous matter - effluvia, you might say - onto his anti-reform pitch. Betsy McCaughey spits on the beanbag and George Will throws it.

Will and McCaughey have been guilty of this unsportsmanlike conduct before. As James Fallows documented so thoroughly, this is a routine they perfected in 1994 (see excerpt below).

To his credit, Will acknowledges that conservatives should stop arguing that reform will lead to health care "rationing," since - as he correctly observes - all goods and services (he uses the word "product," but I don't think that's applicable to healthcare) are already rationed "by price or by politics." Well said. As always, when Will stops throwing spitballs and gets to his real point he's well worth reading. He prefers rationing that is based on price because, he says, "prices produce a rational allocation of scarce resources."

Will should stick with that point and elaborate on it, since it's the crux of his (and other conservatives') argument against health reform. I think that's precisely the wrong way to allocate health care resources, but that's a debate worth having. In fact, it's the debate we should be having.

Instead, Will is too easily tempted to adopt a conservative strategy that appears to come from an old playbook: Toss out false statements or distracting statistics and hope that, as in 1994, the press starts repeating them as if they were either true or relevant.

The astute reader will observe that I've adopted some of Will's literary mannerisms in the writing of this piece. Consider it an homage to a master essayist who, should he so choose, could be a much better advocate for his own political philosophy. Instead he offers us, to use Russell's words, "a chaos full of shooting stars."

The problem with spitballs, as any baseball lover knows, is that the pitcher has a hard time controlling them. Will does neither his readers nor himself a service by continuing to throw them.

_______________________

(From Fallows)

The article's working premise was that McCaughey, with no ax to grind and no preconceptions about health care, sat down for a careful reading of the whole Clinton bill. Appalled at the hidden provisions she found, she felt it her duty to warn people about what the bill might mean. The title of her article was "No Exit," and the message was that Bill and Hillary Clinton had proposed a system that would lock people in to government-run care. "The law will prevent you from going outside the system to buy basic health coverage you think is better," McCaughey wrote in the first paragraph. "The doctor can be paid only by the plan, not by you."

George Will immediately picked up this warning, writing in Newsweek that "it would be illegal for doctors to accept money directly from patients, and there would be 15-year jail terms for people driven to bribery for care they feel they need but the government does not deem 'necessary.'" The "doctors in jail" concept soon turned up on talk shows and was echoed for the rest of the year.

These claims, McCaughey's and Will's, were simply false. McCaughey's pose of impartiality was undermined by her campaign as the Republican nominee for lieutenant governor of New York soon after her article was published. I was less impressed with her scholarly precision after I compared her article with the text of the Clinton bill ... In claiming that the bill would make it impossible to go outside the health plan or pay doctors on one's own, she had apparently skipped past practically the first provision of the bill (Sec. 1003), which said,

"Nothing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services."

RJ Eskow blogs when he can at:

A Night Light
The Sentinel Effect: Healthcare Blog

www.eskowandassociates.com

Follow RJ Eskow on Twitter: www.twitter.com/rjeskow

Comments

[bannorhill]

You rail on George Will for his lack of references yet you suffer from the same lack of references. Your article would have more credibility if you had the references that Will lacked. You don't.

[Dap]

Dear Brother RJ,

An outstanding article, that's why you're the master, doesn't get any better than that.
Just wanted to drop in and wish ya a Happy fourth of July. Agape, dap

[Rhetticent]

Any reform, to be meaningful, has to approach all of these problems. We need to keep what is good, and fix the rest. Personal health has to become a personal responsibility. We need to compensate family practitioners better than specialists. We need to allow insurers to pool nationally, and to offer varieties of policies: minimal coverage with add-ons that cost more if you want them. We need tort reform. My problem with the current proposals is that it is like putting a band-aid on a sucking chest wound.

[Guitanguran]

Well considered sir.

[jinxed]

"tort reform" when tort filings is around 0.04% of the reason we've had a 2300% increase in 10 years? And CEO compensation has absolutely nothing to do with it. What don't you get about this?

[Rhetticent]

(Will someone please provide some working examples of a "health care free market"?)

I would propose that you look at the way healthcare was provided prior to the invention of health insurance. Health care was provided on a fee-for-service basis.

Health insurance came about after WWII as a result of price and salary freezes that left employers hunting for ways to compensate valuable employees when they couldn't raise wages. Because of the pooling of funds using the insurance model, health care could be provided at a low cost to large numbers of people. Because hospitals and doctors quickly realized that the consumer no longer cared about the costs because the insurer was paying it. the system rapidly became hugely inflated with resulting large increases in profits. Hence the change over the 50's-60's-70's from non-profit, city or church owned hospitals, to massive, corporate owned hotel-like facilities. Each hospital bought expensive technology like CAT's and MRI's, and then of course had to use them a lot so they could bill enough to pay for them.

Everybody in this situation deserves blame. Doctors, hospitals have become fat and greedy courtesy of insurance/ Medicare payments. Government has responsibllity for the mismanagement of Medicare and Medicaid. Individuals who do not care about their own health, or who do not question why treatments are prescribed or even what they do, are to blame. The legal system, which has created a paranoid system of defensive medicine, also is hugely guilty.

[vm12608]

Thank you MoeB. Well said. That insurance companies are afraid of competition should tell people everything they need to know, that giving people a choice scares insurance companies should tell people everything they need to know. Scare tactics abound in the world of those who feel they have the most to lose when the playing field is leveled. Would a public option force some insurance companies out of business? Of course it would unless they figured out that being in business means you have to provide a good quality product or service at a fair price. People do not resent companies making a profit - they resent companies gouging out the eyeballs of their customers for shoddy goods and services. There is a difference between making a profit and being obscene. Look at the new Goldman Sachs CEO making $50 mil / year. What does he do on a daily basis that is worth $136,900 a day (based on 365 days /yr) or or $13,690 and hour based on a 10 hour work day? We have completely lost our sense of proportion in this country. I don't even want to start in on entertainers and sports figures...

[rogi99]

One thing that keeps bugging me is the fact that people keep treating health care as some "product". Health of a person (and survival or life in the ultimate extension of the term) can not be treated as some commodity because of its inherent "abuseability". Drive for survival is so deeply ingrained in all of us that it is very easy to have someone who is selling this "product" to manipulate and play on the fears of the people. This is the inherent problem with this - health is so basic that it can not be morally acceptable in a civilised society to be selling it on the market and for someone to make profit(!) from someone else's misery. Situation like this is ripe for all the kinds of abuse (which is as we all know going on). It is deeply saddening that we are still alowing this to be the case. If we are all about choice (as society) why couldn't we have the system that Germany has (and which works quite well!) - have basic health insurance that is guaranteed by the governement and it is covering everyone and has certain limitations to it, but is a good comprehensive insurance and than (if one wants more) there are different private insurers (not for profit!!!) from which one can buy additional coverage that suits their needs/desires.

[hunt49]

Thank you! This concept of a 'consumer model' should really scare the h#&% out of rational people. When people are sick and in need of care, they are not going to engage in consumer-choice behavior. The model doesn't fly.

Even if it did, could it be a more callous approach? The model demands a re-drafting of the Hippocratic Oath - "First, do a cost/benefit analysis. Then, do no harm."

[MoeB]

HuffPost's Pick

It simply boils down to this: We already KNOW what happens with private insurance. It is time to try something different. I'm actually for single-payer, but if this public option leads to that eventually, then I'm all for it.

I'm also not of the belief of many conservatives that government cannot do anything right. The problem isn't government in and of itself, it is WHO we choose to run government. People complain about the post office, but everyday that they deliver mail, mine has arrived (with few exceptions). Further, I don't know of any corporations or "free market" companies who've never received complaints about lack of quality of service.

Both corporations and government are run by PEOPLE, and people are flawed, so I wish we'd get over this whole 'private is better than public because public run things aren't run well' meme.

The bottom line is this: The healthcare corporations are NOT, I repeat NOT interested in the health of the people it insures outside of trying to only cover those who will pay into the system and not get much out of it. It's goal is profit. And if your health gets in the way of that, then you are probably screwed. Presenting a public option helps level the playing field as, before the idea was floated, I didn't see any of those companies rushing to provide more efficient, cost-effective, and cheaper medical insurance. That tells me everything I need to know.

[Guitanguran]

"I'm also not of the belief of many conservatives that government cannot do anything right."

Its not a matter of whether the government can get something done. My mail gets delivered as well, but the USPS typically subcontracts FedEx and UPS to get it 'there'.

"I wish we'd get over this whole 'private is better than public..."

I still disagree. Private enterprise is still better by far than government in providing goods and services. It may not fit all circumstances, but the following example shows us how things could be.

Since its introduction as a medical procedure, Lasik surgery has become much simpler, more technologically advanced, less invasive, and most importantly, delivered at a much lower cost.

Why is that?

1.) The patient has to pay for it out of pocket. When you know what it costs, you'll shop around.


2.) Because its out of pocket, doctors HAVE to compete for client dollars. Buying better equipment, improving technology and productivity, ultimately benefiting the patient with better service at lower cost. Not because they're angels. They're out to make money! But their employees and families, the equipment manufacturers, and ultimately the patient benefits from guys just trying to make a buck.

No insurance, no government 'program' to muck it all up

Now you may say "Well that's an elective surgery, blah blah blah, but the fact remains that the government would never come up with a program that would get that result, ever.

[JuliaRain]

How about with Cancer? I didn't know people who are dying had the time or the strength to go "shop around".

At least with lazic I CHOOSE to have it done. I can wait to have lazic nor will I die if I don't get lazic.

Cancer? Nobody chooses to get cancer. You see why there is a problem here? Your analogy is misleading and inaccurate.

What should one do if they have a pre-existing condition? Little "choice" in shopping around.

Luxury health care will always be around. You should not worry about that.

You guys complain about USPS, but fail to realize that corporations get Post office Welfare too. Maybe if they had to pay full price for all the garbage flyers, credit card apps, and other junk mail they send out everyday, the USPS could pull in a profit.

You are just denigrating the debate.

[MoeB]

Actually, it IS a matter of whether government can get something done. And it may be true that USPS may subcontract to other mail delivery services, but like I've said before, that speaks more to the PEOPLE running those government functions than government itself.

And your examples speaks to competition, which BEGS the question: why is it such a bad thing for the government to present an additional option for healthcare coverage (see COMPETITION)?? I mean, if private industry is SOOOO much better at everything, then a little competition from our horrible government shouldn't bother anyone, right?

And if you aren't willing to give a public option a chance, then how do you KNOW that the government couldn't do a better job? Again, maybe your experiences with private industry have ALWAYS been terrific, but back in reality with the rest of us, we understand that competition is necessary to ensure better quality service.

But sorry, I'm never gonna buy into this whole 'greed is good' mantra. I know plenty of people who aren't greedy who still manage to "make a buck".

[winchestereast]

well thanks for explaining, i think, why g.f. will has any aura of credibility - it sure isn't for content - well, then, full marks for style and delivery to will - the health care debate is being run largely by people with no knowledge of the facts - even pres obama yesterday told us that physicians pass on the cost of caring for uninsureds to the rest of us ,IGNORING THE FACT that most of us get our contracts with fee schedules set by insurers - we just take care of uninsureds and write off the charges - and most physicians, especially in primary care, have no incentive to order unneeded tests, procedures, visits - no $ in it, and we're already stretched beyond our limits because NO ONE IS GOING INTO PRIMARY CARE - too labor intensive, too much night call, too many hassles - i remember the good old 80's and 90's- when hmo's shifted risk to physicians, sued many of us to recover the cost of caring for patients we'd never seen, not in our network, who'd been assigned to us by the hmo's - guess what? you can't beat them - when they say they'll play nice now, don't believe it - how're they gonna pay a ceo 205,000,000 playing fair with physicians and patients?

[normathumb]

Just couldn't read this to the finish. The only thing worse than reading a Will column is reading a column about a Will column. Will's work is like a tasty creampuff, all fat and sugar with no real nutritional value whatsoever. The kindest you can say is it is the best conservatives have to offer since Buckley died. It was a dark and stormy...

[MarcusT]

I can't shake the feeling that no one in this debate has ever needed serious health care.

[Guitanguran]

I, for one, can't shake this feeling that no one in this debate has seriously considered the people making decisions on what form of access for healthcare we'll wind up with in this country.

[JuliaRain]

Blah, bah, lbah. blah...

You are short sighted with such a comment. You do realize how much more devastating it will be to America if its citizens are suffering and dying, don't you? Or are you that obtuse?

[Guitanguran]

Mr. Eskow,

You made some veiled reference to some of my posts, indicating I was employing facts, neglecting "to include enough specificity to allow for rebuttal."

"Medical conditions account for two-thirds of American bankruptcies today."

Pot and Kettle, Mr. Eskow.

[Rhetticent]

I've been practicing bankruptcy law for 25 years. There's not been a single client who has NOT been advised by some one along the line to characterize his or her bankruptcy as a "Medical" bankruptcy, no matter how much medical debt has been discharged. Lenders like it if you can use such a catchy explanation. I wonder what the author of this article would consider to be a "medical bankruptcy".

[Tim303]

HMOs already ration health.

[Guitanguran]

To use an analogy, would you prefer a headache, or brain cancer?

[JuliaRain]

What? Please explain this analogy. Your previous one about lazic was ridiculous.

[drricklippin]

RJ Eskow-

I must admit I have been seduced by George Will's writings before.

But because I know this health care reform issue on this occassion I was not.

Thank for reinforcing my views with your good critique of the Willl column

Thanks to YOU I will read him more carefully now on ALL matters

(But the man can sure write with eloquence- eloquence and beauty not necessarily being truth)

Be Well,

Dr. Rick LIppin
Southampton,Pa
http://medicalcrises.blogspot.com

[DanBest]

To vagabondvet and guitaranwhateveryoucallyourself:

You claim that not as many people go bankrupt from paying medical bills as the left claims. Fair enough.
Please explain to me why any family in the richest country in the world should go bankrupt because they are trying to save the life of a loved one? Please put a number amount on it.
How many are acceptable?
Should anyone be forced to make a life or death decision about a sick child based on how much they can afford?
Then tell me how many people in Japan, England, France and Germany have to file bankruptcy under the same circumstances?

I used to be entertained by some of the over-the-top arguments given by libertarians. Now I just think it's intentional cruelty. A fundamental lack of empathy for suffering. A belief that somehow through your hard edged rhetoric that you will escape the fate you consign others to. Unless you are ultrarich, you too may find yourself hanging over the abyss of bankruptcy. Unless you can pay out-of-pocket you too might have to take out a loan to pay for a procedure your insurance company refuses to pay. That's reality in America. You both claim to argue in good faith. Please answer my questions.

[Guitanguran]

By the way, Mr. DanBest, I don't think its too hard to actually look at the name and get it right. Its a matter of respect that I extend to you, if I'm to address you directly. Why not the same for me? Can we start there?

"Please explain to me why any family in the richest country in the world should go bankrupt because they are trying to save the life of a loved one? Please put a number amount on it."

You're putting up a straw man/family here, Mr. DanBest. The point about the figures is that they're inflated to advance an agenda. Its not the crisis issue that its portrayed to be. Well, if its not a full-blown national crisis, why are we advancing a trillion dollars toward it when we're already up over our eyeballs in debt? Would there be another way to take care of those people that are actually facing bankruptcy because of a catastrophic illness without spending a trillion $s? I bet there is. Not a matter of empathy. Its a matter of dealing with facts and using common sense.

The question should be, "Is it the government's job to make sure no one goes bankrupt no matter the circumstances?"

Its a legitimate question.

[DanBest]

Typical. Guitanguran. Did I get your handle right? Are you now less offended?
This "strawman" you refer to are actual flesh and blood people. I've known families that were put in this bind. Do you?
You complain about strawmen and then create your own about the government making sure no one goes bankrupt. You leap from the issue at hand to broaden it to mean anyone who gets in a financial bind. No it is not the government's job. But you don't answer any of the questions I posed. To claim that the numbers are to advance an agenda is a distraction. People go bankrupt trying to save lives and that's wrong. You don't bother to argue that it doesn't happen, just that it doesn't happen as often as is claimed. First admit that it happens. Then we can discuss solutions. You bet that there is a better solutiion but I'm still waiting for your side to make them. I'll ask again:

Why should any family in the US go bankrupt because they are trying to save the life of a loved one?
How many medical bankruptcies are acceptable?
Should anyone be forced to make a life or death decision about a sick child based on how much they can afford?
Then tell me how many people in Japan, England, France and Germany have to file bankruptcy under the same circumstances?

Don't evade the questions. Just answer them and we can proceed from there :)

[LeighAnnes]

Boy did you waste your time trying to talk to these people.

[m5marc]

Okay, listen up. There can't be HEALTH CARE SYSTEM reform in the US, because we don't have a HEALTH CARE SYSTEM. We have an INSURANCE CARE SYSTEM where the health and well-being of the insurance companies is more important than the health and well-being of the patients. Until and unless there is a fundamental change in who realy matters - it's all B.S..

[Guitanguran]

Do you serious consider that the folks in Washington care for your well being any more than a private company?

Consider the cap and trade bill that just made it through the house. 85% of the revenue that was to be generated had to be diverted to various special interest groups just to make it through the House. 3.5 Billion $ alone for the state of Ohio to buy votes there. Essentially, it negated the purpose of the bill.

So, who is being served here? It ain't you, and it ain't me.

A "D" or an "R" beside someone's name is no guarantee that they're looking out for you or care about what's important to you or me. Its bigger than that. Its about how much of your life you're going to have control over and how much the government will have. One of the provisions in the Cap and Trade bill was a home seller would be required to meet certain energy requirements before being able to sell their home. Literally, you'd have to have a federal 'home inspector' sign off on it first. What if I can't afford to upgrade it? What if the buyer will take the house 'as is' and fix it themselves?

Tough toenails, your freedom over your own property will be taken away from you.

[JuliaRain]

And it is foolish to think or believe that medical profiteers have any interest in human beings.

[LeighAnnes]

Agreed. The profit incentive for denying services needs to be taken out of the process. Currently, insurance companies make money by denying services not providing them.

[Bladernr1001]

Ok...so let's take the "profit motive" out of health care. So if there is no particular montatary reward for doing a good job then what motive should we insert to ensure that everyone is doing their best job?

You liberals paint the quest for profit as some evil thing. It is not by and large. It is precisely what motivates most to do a good job...which earns continued business...and the ability to pay ones own bills.

In a government health care system the profit motive replaced by a dictatorship with control over your health care decisions. Wow...as we can see from history dictatorships work really, really well...don't they?

[DesertDogAlpha]

We have a health care system - and it is a system of small businesses (doctor's offices), that works on a semi-cooperative basis with larger businesses (hospitals and hospital systems), and that is essentially funded by a dog's breakfast of insurance companies and various state governments and the federal government. Do we want to mandate that the small business people must now work for the federal government? No one wants to answer that question - why is that? Will all doctors be paid on a scale equal those working for the military or VA? What if they won't do it? Do we, as indivduals, want to have the capacity to choose and change doctors or do we want to have the same choice as we have in terms of the clerk who serves us at the DMV. Will diversity be as important in doctor assignment and selection as competence? If Michelle gets really sick (God forbid) will Barack be willing to accept a randomly assigned clinical healthcare provider, just like everyone else would get? He won't, and neither will the rest of us who are satisfied with the health care we now receive. How low can we take the standard of healt care for the 80 percent of us who are now satisfied in order to get a minimally acceptable standard for those who now don't have good access? What about taxpayer funded health care for illegals - and who have children here, with those children then being called citizens?