# Conservative opinion on US health care **URL:** \ **Category:** Great Debates\ **Created:** [July 26, 2009, 9:42pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356 "2009-07-26T21:42:05Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Polerius](https://avatars.discourse-cdn.com/v4/letter/p/d78d45/32.png) [@Polerius](https://boards.straightdope.com/u/Polerius)\ **Post date:** [July 26, 2009, 9:42pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/1 "2009-07-26T21:42:05Z")
Conservatives are against the latest health care reform effort, which seems to be sinking (or has already sunk), and seem to be against any attempt to change the status quo (especially if that change involves the government) My question is, what is the opinion of conservatives on the state of US health care? 1. They think everything is fine, no need to change anything. 2. They think health care costs are indeed getting out of hand, but we should do nothing because we should just let the free market decide what the cost of health care should be, even if it causes high costs which negatively affect the economy. 3. They think health care costs are indeed getting out of hand, and we need to find a market-based solution, not a government-based one, but no such solution has yet been proposed. 4. They think health care costs are indeed getting out of hand, and we need to find a market-based solution, not a government-based one, and they in fact have proposed such a solution. 5. Other? ---
**Author:** ![athelas](https://avatars.discourse-cdn.com/v4/letter/a/5e9695/32.png) [@athelas](https://boards.straightdope.com/u/athelas)\ **Post date:** [July 26, 2009, 9:49pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/2 "2009-07-26T21:49:00Z")
> [@Polerius](#): > > 1. They think health care costs are indeed getting out of hand, and we need to find a market-based solution, not a government-based one, and they in fact have proposed such a solution. Milton Friedman: [http://www.hoover.org/publications/digest/3459466.html](http://www.hoover.org/publications/digest/3459466.html). Read the whole thing: it’s a good read and speaks for an underrepresented argument in today’s climate. If nothing else, you should know your non-strawman opposition. > [@](#): > > Two simple observations are key to explaining both the high level of spending on medical care and the dissatisfaction with that spending. The first is that most payments to physicians or hospitals or other caregivers for medical care are made not by the patient but by a third party—an insurance company or employer or governmental body. The second is that nobody spends somebody else’s money as wisely or as frugally as he spends his own. These statements apply equally to other OECD countries. They do not by themselves explain why the United States spends so much more than other countries. > > No third party is involved when we shop at a supermarket. We pay the supermarket clerk directly: the same for gasoline for our car, clothes for our back, and so on down the line. Why, by contrast, are most medical payments made by third parties? The answer for the United States begins with the fact that medical care expenditures are exempt from the income tax if, and only if, medical care is provided by the employer… > > We are headed toward completely socialized medicine—and, if we take indirect tax subsidies into account, we’re already halfway there. He then goes on to favor removing the tax subsidy of employer healthcare, which would 1. raise revenue 2. remove a big source of labor rigidity (can’t quit your job or you’ll lose your insurance) 3. promote competition between insurance firms to cut costs to consumers, rather than bag big corporate contracts. > [@](#): > > The ideal way to do that would be to reverse past actions: repeal the tax exemption of employer-provided medical care; terminate Medicare and Medicaid; deregulate most insurance; and restrict the role of the government, preferably state and local rather than federal, to financing care for the hard cases. However, the vested interests that have grown up around the existing system, and the tyranny of the status quo, clearly make that solution not feasible politically. Yet it is worth stating the ideal as a guide to judging whether proposed incremental changes are in the right direction… > > Medical savings accounts offer one way to resolve the growing financial and administrative problems of Medicare and Medicaid. It seems clear from private experience that a program along these lines would be less expensive and bureaucratic than the current system and more satisfactory to the participants. In effect, it would be a way to voucherize Medicare and Medicaid. It would enable participants to spend their own money on themselves for routine medical care and medical problems, rather than having to go through HMOs and insurance companies, while at the same time providing protection against medical catastrophes. > > A more radical reform would, first, end both Medicare and Medicaid, at least for new entrants, and replace them by providing every family in the United States with catastrophic insurance (i.e., a major medical policy with a high deductible)**[Note: universal healthcare! sort of]**. Second, it would end tax exemption of employer-provided medical care. And, third, it would remove the restrictive regulations that are now imposed on medical insurance—hard to justify with universal catastrophic insurance. ---
**Author:** ![Squink](https://avatars.discourse-cdn.com/v4/letter/s/b5e925/32.png) [@Squink](https://boards.straightdope.com/u/Squink)\ **Post date:** [July 26, 2009, 9:50pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/3 "2009-07-26T21:50:33Z")
1. If they stop it, it’ll be Obama’s Waterloo. ---
**Author:** ![Polerius](https://avatars.discourse-cdn.com/v4/letter/p/d78d45/32.png) [@Polerius](https://boards.straightdope.com/u/Polerius)\ **Post date:** [July 26, 2009, 10:09pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/4 "2009-07-26T22:09:33Z")
> [@athelas](#): > > Milton Friedman: [http://www.hoover.org/publications/digest/3459466.html](http://www.hoover.org/publications/digest/3459466.html). Read the whole thing: it’s a good read and speaks for an underrepresented argument in today’s climate. Thanks for the link. I’ll take a look. [QUOTE=Milton Friedman] No third party is involved when we shop at a supermarket. We pay the supermarket clerk directly: the same for gasoline for our car, clothes for our back, and so on down the line. Why, by contrast, are most medical payments made by third parties? The answer for the United States begins with the fact that medical care expenditures are exempt from the income tax if, and only if, medical care is provided by the employer… [/QUOTE] I don’t want to derail the thread into a side debate, since I want to get conservatives’ opinion on the state of US health care, but I wanted to address the above point: There is one \*huge \*difference between health care costs and paying at the supermarket, paying for gas, or paying for clothes, and it is not simply the existence of employer-based health care. [ul] [li]We all go to the supermarket quite regularly and pay small, and fairly predictable, amounts of money[/li][li]We put gas in our cars quite regularly and pay small, and fairly predictable, amounts of money[/li][li]We buy clothes fairly regularly and pay small-to-medium and fairly predictable, amounts of money[/li][/ul] But, we go to the doctor on a random basis, and when we do, the amount of money can be huge. If you suddenly need a liver transplant, I’m assuming it will cost in the hundreds of thousands of dollars. I don’t think anyone goes to the supermarket and suddenly finds that they owe hundreds of thousands of dollars. It’s quite disingenuous of Milton Friedman to say that the only/main reason “Why, by contrast, are most medical payments made by third parties?” is that “the fact that medical care expenditures are exempt from the income tax if, and only if, medical care is provided by the employer”. I think they are made by third parties because people need medical insurance for the rare, very costly incidents, just like other types of insurance that cover rare, very costly incidents. ---
**Author:** ![Polerius](https://avatars.discourse-cdn.com/v4/letter/p/d78d45/32.png) [@Polerius](https://boards.straightdope.com/u/Polerius)\ **Post date:** [July 26, 2009, 10:14pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/5 "2009-07-26T22:14:43Z")
> [@athelas](#): > > Milton Friedman: [http://www.hoover.org/publications/digest/3459466.html](http://www.hoover.org/publications/digest/3459466.html). Read the whole thing: it’s a good read and speaks for an underrepresented argument in today’s climate. Do you know if Friedman’s opinion reflects the majority of conservatives’ opinion on the matter? ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [July 26, 2009, 10:31pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/6 "2009-07-26T22:31:31Z")
> [@Squink](#): > > 1. If they stop it, it’ll be Obama’s Waterloo. And it will be excellent news for the McCain campaign! ---
**Author:** ![smiling\_bandit](https://avatars.discourse-cdn.com/v4/letter/s/e9a140/32.png) [@smiling\_bandit](https://boards.straightdope.com/u/smiling_bandit)\ **Post date:** [July 26, 2009, 11:26pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/7 "2009-07-26T23:26:07Z")
> [@Polerius](#): > > Do you know if Friedman’s opinion reflects the majority of conservatives’ opinion on the matter? Nobody knows that, because nobody has asked us. ---
**Author:** ![flickster](https://avatars.discourse-cdn.com/v4/letter/f/7bcc69/32.png) [@flickster](https://boards.straightdope.com/u/flickster)\ **Post date:** [July 26, 2009, 11:37pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/8 "2009-07-26T23:37:36Z")
> [@elucidator](#): > > And it will be excellent news for the McCain campaign! Whereas luci once again beats a long dead horse, if it was ever alive in the first place… ---
**Author:** ![Sage\_Rat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sage_rat/32/399_2.png) [@Sage\_Rat](https://boards.straightdope.com/u/Sage_Rat)\ **Post date:** [July 26, 2009, 11:46pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/9 "2009-07-26T23:46:25Z")
> [@Polerius](#): > > 1. Other? Firstly, it should be pointed out that it’s unlikely that the nearly doubled cost of health care in the US has much to do with our being a non-UHC nation. A single bargainer might be able to shrink that amount paid for pharmaceuticals, but pharmaceuticals are already only [10%](http://www.healthpopuli.com/uploaded_images/US-National-Health-Expenditures-2006-767250.jpg) of overall cost. Whether preventative care cuts cost, [it really isn’t all that clear](http://content.nejm.org/cgi/content/full/358/7/661). Essentially we just have a really inefficient system with a lot bogging it down all across the board. And while it’s easy to say, “Well let’s just all build it anew from scratch!” We simply can’t afford the amount turmoil that would produce. Among other things, it would have a massive effect–probably resulting in extreme layoffs at insurance companies across the nation, not to mention changing building a whole new system centrally and linking up all the hospitals and private practitioners to it. Also it should be noted that the current estimate for the new plan expects it to cost more per person than what we already have. Cost savings isn’t accomplished by spending more. That’s just one of those definitional things. Now, personally I think that a system like [Israel’s](http://en.wikipedia.org/wiki/Health_care_in_Israel) would be alright for us. Though instead of having the government pay a minimum to all insurance companies, they would simply require that all insurance companies have a minimum package which anyone can join in on, and if you don’t sign up for on yourself, you’ll be assigned to one (say by whoever has the closest office when you first go in to the doctors). But in terms of actual health care cost reduction, I think we would need to go through and find all of the various holes leaking money and start cutting those down. We might want to impose export tariffs on foreign countries when dealing with medical supplies and pharmaceuticals, rerouting that money back to domestic medical research. We might also make it more difficult to go and sue a doctor or his entire hospital and team and limit the total payout, so as to reduce both medical payouts and medical malpractice fees.\* Overall, I suspect that are several dozen things that could be and need to be done to lower costs. Though I’ll also note that this needs to be done in a slow and linear fashion or you’re going to cause yet another market crash. - [Which does appear to be able to reduce the cost to doctors, by a significant amount (30%).](http://www.dallasnews.com/sharedcontent/dws/bus/columnists/jlanders/stories/DN-Landers_21bus.State.Edition1.9be351.html) Admittedly that article then goes on to say that overall health care costs still rose, but doesn’t present any reason to think that has anything to do with the malpractice caps. ---
**Author:** ![flickster](https://avatars.discourse-cdn.com/v4/letter/f/7bcc69/32.png) [@flickster](https://boards.straightdope.com/u/flickster)\ **Post date:** [July 26, 2009, 11:46pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/10 "2009-07-26T23:46:37Z")
I would be ok with the establishment of government run walk-in health clinics where the needy could get non-emergency medical attention. The other side of this would be to restrict emergency room service to emergency medical treatment only. There would also need to be some qualification on the “needy” status. If you are gainfully employed and have health insurance available but just elect not to enroll, you’re not needy (over a certain income level). ---
**Author:** ![IdahoMauleMan](https://avatars.discourse-cdn.com/v4/letter/i/71c47a/32.png) [@IdahoMauleMan](https://boards.straightdope.com/u/IdahoMauleMan)\ **Post date:** [July 26, 2009, 11:47pm UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/11 "2009-07-26T23:47:31Z")
> [@Polerius](#): > > Thanks for the link. I’ll take a look. > > [ul] > [li]We all go to the supermarket quite regularly and pay small, and fairly predictable, amounts of money[/li][li]We put gas in our cars quite regularly and pay small, and fairly predictable, amounts of money[/li][li]We buy clothes fairly regularly and pay small-to-medium and fairly predictable, amounts of money[/li][/ul] > But, we go to the doctor on a random basis, and when we do, the amount of money can be huge. If you suddenly need a liver transplant, I’m assuming it will cost in the hundreds of thousands of dollars. I don’t think anyone goes to the supermarket and suddenly finds that they owe hundreds of thousands of dollars. > > It’s quite disingenuous of Milton Friedman to say that the only/main reason “Why, by contrast, are most medical payments made by third parties?” is that “the fact that medical care expenditures are exempt from the income tax if, and only if, medical care is provided by the employer”. I think they are made by third parties because people need medical insurance for the rare, very costly incidents, just like other types of insurance that cover rare, very costly incidents. I would disagree with your assumption that we go to the doctor on a random basis. I would also disagree that insurance can only cover rare, costly incidents. There are varying degrees of insurance coverage that could exist if the market was deregulated and allowed to price for risk. Unfortunately, that is not the case today as it is one of the most horribly over-regulated markets in America. ---
**Author:** ![athelas](https://avatars.discourse-cdn.com/v4/letter/a/5e9695/32.png) [@athelas](https://boards.straightdope.com/u/athelas)\ **Post date:** [July 27, 2009, 12:06am UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/12 "2009-07-27T00:06:16Z")
The majority of medical \*transactions \*are small predictable sums. The risk of big budget-breakers can be priced through catastorphic insurance, much as we have fire or hurricane insurance. Notably, Friedman notes that the market could theoretically take care of this risk, but opts for a catastrophic care mandate, probably because ER is currently provided without question whether or not people pay into a catastrophic insurance package, and that’s unlikely to change. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [July 27, 2009, 12:47am UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/13 "2009-07-27T00:47:23Z")
> [@Polerius](#): > > 1. They think everything is fine, no need to change anything. > > 2. They think health care costs are indeed getting out of hand, but we should do nothing because we should just let the free market decide what the cost of health care should be, even if it causes high costs which negatively affect the economy. > > 3. They think health care costs are indeed getting out of hand, and we need to find a market-based solution, not a government-based one, but no such solution has yet been proposed. > > 4. They think health care costs are indeed getting out of hand, and we need to find a market-based solution, not a government-based one, and they in fact have proposed such a solution. > > 5. Other? A lot of them are trying to be in camp 4. However, I think the problem is in who’s deciding this. Congressmen are, as a matter of pure system selection, professional flatterers by nature, not competent administrators. The talk radio boys seem even worse. So there’s a very strong tendency toward attitude 2. But attitude 2 overlooks the fact that the government is a supplier in the market–in fact a monopoly supplier–of trained physicians. One of the unfortunate effects of Medicare is that we are dependent on Congress to make sure we’re training enough physicians. We haven’t been. For ten years. As a participant in the market, Congress has a responsibility to do the research & keep up with its demand, or the market fails. If it can’t do that–and clearly it can’t when the GOP are running it–it needs to appoint someone else to take responsibility for the system. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [July 27, 2009, 2:01am UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/14 "2009-07-27T02:01:20Z")
> [@Squink](#): > > 1. If they stop it, it’ll be Obama’s Waterloo. And their bridge too far. I’m from Missouri. We’re proud of Harry Truman here. In 1949, he tried to socialize medicine &/or health insurance & failed. At the time, the argument was that private non-profits had insurance under control. Well, now that’s no longer the case. You can find a lot of stupid people who think individual health savings accounts will solve this, but there are even more stupid people who want to know why the government isn’t helping them. Republicans, social conservatives, & dynamists vote in higher numbers, but you don’t need to register to join a riot or a lynch mob. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [July 27, 2009, 2:03am UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/15 "2009-07-27T02:03:25Z")
> [@IdahoMauleMan](#): > > There are varying degrees of insurance coverage that could exist if the market was deregulated and allowed to price for risk. Unfortunately, that is not the case today as it is one of the most horribly over-regulated markets in America. How on earth can you honestly run _un_regulated insurance? ---
**Author:** ![IdahoMauleMan](https://avatars.discourse-cdn.com/v4/letter/i/71c47a/32.png) [@IdahoMauleMan](https://boards.straightdope.com/u/IdahoMauleMan)\ **Post date:** [July 27, 2009, 2:05am UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/16 "2009-07-27T02:05:25Z")
> [@foolsguinea](#): > > How on earth can you honestly run _un_regulated insurance? The same way you can run unregulated anything else. The company offers a product or service for a specified price. The customer decides whether or not to accept it. And that’s it. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [July 27, 2009, 2:06am UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/17 "2009-07-27T02:06:14Z")
> [@athelas](#): > > Notably, Friedman notes that the market could theoretically take care of this risk, but opts for a catastrophic care mandate, probably because ER is currently provided without question whether or not people pay into a catastrophic insurance package, and that’s unlikely to change. I sort of agree with Friedman here. At minimum, we should pull emergent care out of the “market,” because its purchase is not driven by rational decisions. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [July 27, 2009, 2:07am UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/18 "2009-07-27T02:07:16Z")
> [@IdahoMauleMan](#): > > The same way you can run unregulated anything else. > > The company offers a product or service for a specified price. > > The customer decides whether or not to accept it. > > And that’s it. In _insurance._ :rolleyes: ---
**Author:** ![IdahoMauleMan](https://avatars.discourse-cdn.com/v4/letter/i/71c47a/32.png) [@IdahoMauleMan](https://boards.straightdope.com/u/IdahoMauleMan)\ **Post date:** [July 27, 2009, 2:08am UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/19 "2009-07-27T02:08:38Z")
> [@foolsguinea](#): > > In _insurance._ :rolleyes: We must not be understanding each other here. I meant for insurance. What am I saying that is not clear? ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [July 27, 2009, 2:29am UTC](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356/20 "2009-07-27T02:29:24Z")
Insurance without regulation is just taking people’s money & not giving them anything. [Next page](https://boards.straightdope.com/t/conservative-opinion-on-us-health-care/504356.md?page=2)