# What sort of health care reform do conservatives actually support? **URL:** \ **Category:** Great Debates\ **Created:** [August 14, 2009, 9:56pm UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454 "2009-08-14T21:56:14Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![monstro](https://avatars.discourse-cdn.com/v4/letter/m/ba9def/32.png) [@monstro](https://boards.straightdope.com/u/monstro)\ **Post date:** [August 15, 2009, 10:21pm UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/61 "2009-08-15T22:21:21Z")
> [@Frank](#): > > Yep. Both. > > That little said, I’ve been convinced for years that health insurance should be more along the lines of car insurance. Spend your own money and none of the insurance company’s on the little shit - a doctor’s check-up or a ding in the fender; spend some of your own money and some of the insurance company’s on the medium shit - physical therapy for a rotator cuff or a windshield replacement; spend very little of your own money and very much of the insurance company’s on the major shit - colon cancer surgery or a car totalled by the bus driver missing a red light. > > I feel that something is wrong with insurance that covers a $100 doctor visit, but doesn’t cover the $10,000 treatment that results from that. I agree with you, in principle. But the analogy with car insurance breaks down very quickly. Car insurances covers you in case of an accident, not when your transmission gives out. It also doesn’t cover the myriad of small problems (busted air conditioner, shaky steering column) your “lemon” may have as soon as you drive it off the lot. No one goes to their insurer to get these things taken care of, because that’s not the point of car insurance. Health insurance shouldn’t function at all like car insurance, because many times we’re sick because of “break downs” not because of accidents. I agree that people should pony up for routine doctor’s visits. However, human nature being the way it is, most people will not pay hundreds of dollars only to be given a clean bill of health. If I wake up in the morning and I’m not in pain, I’m not dizzy or fatigued, and I have an appetite, what’s my motivation to go to the doctor? If I’m conscientious and I’m not broke, I won’t need extra motivation, but I don’t think most people are conscientious enough to seek out preventative medicine on their own dime. They’ll go to the doctor when they’ve been pooping blood for three weeks, they’re two hundred pounds overweight, and they can’t breath at night. But by then, we’re already into the “catastrophic” level of health care. If we could bring costs down significantly, then going to the doctor routinely wouldn’t be so expensive and people wouldn’t let their “dings” develop into dead transmissions. Then we could go with your plan. ---
**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:** [August 16, 2009, 12:36am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/62 "2009-08-16T00:36:28Z")
> [@Der\_Trihs](#): > > conservatism is rife with people. Yes, yes it is. Of course, we live in a republic, people are sort of a necessary evil to political success. ---
**Author:** ![Der\_Trihs](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/der_trihs/32/233_2.png) [@Der\_Trihs](https://boards.straightdope.com/u/Der_Trihs)\ **Post date:** [August 16, 2009, 12:47am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/63 "2009-08-16T00:47:11Z")
> [@bjbrashier](#): > > Come on, guys. You really think that’s indicative of the majority of conservatives? Would you like me to start pointing out those same kinds of people on the liberal side? Yes, they ARE indicative of the majority of conservatives. They are the conservative norm, not the fringe. And while there are naturally crazies on the Left, they are neither as numerous, as prominent and not even close to being as powerful as those on the Right. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [August 16, 2009, 1:42am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/64 "2009-08-16T01:42:21Z")
Conservatism isn’t about ideology, its about resistance to change. The American Republicans found themselves in a position parallel to the Chinese Communists. The ideology is wholly bankrupt, but they cling to power like a lamprey. There’s nothing remotely “Communist” about them any more, anymore than they are People’s Democracy, thats simply the sham they dress up in, like an old whore in a flimsy negligee that is far, far too revealing. They resist change because change means that power and wealth will be frivolously squandered on the undeserving. Power often grants a certain clarity of vision, that permits the powerful to see that, for the good of all, it is best that power and wealth should be stewarded by those who already have it. Saves time, for one thing. There is no philosophy amongst the Pubbies anymore than dialectical materialism guides the Party in China. They are both conservative, that one purports to revere Lenin and the other pretends to respect Hamilton and Burke doesn’t mean shit to a tree. They are conservative. I’ve seen their ways too often for my liking. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [August 16, 2009, 1:49am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/65 "2009-08-16T01:49:22Z")
Pretty much _any_ plan, as long as: 1. It’s proposed by a conservative instead of a liberal 2. Beck, Hannity, Limbaugh and their ilk get a their talking points 3. It 's got “American”, “Patriot”, “Family” or any combination of the three in the title, and 4. They can dig up some obscure nutcase that they can claim speaks for liberals who opposes it. ---
**Author:** ![Dynamo](https://avatars.discourse-cdn.com/v4/letter/d/d2c977/32.png) [@Dynamo](https://boards.straightdope.com/u/Dynamo)\ **Post date:** [August 16, 2009, 2:09am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/66 "2009-08-16T02:09:32Z")
> [@Try2B\_Comprehensive](#): > > We’re talking about pap smears and catheters, not Tom Cruise face transplants. Yeah, that kind of stuff doesn’t add up. /Sarcasm ---
**Author:** ![bjbrashier](https://avatars.discourse-cdn.com/v4/letter/b/e68b1a/32.png) [@bjbrashier](https://boards.straightdope.com/u/bjbrashier)\ **Post date:** [August 16, 2009, 4:08am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/67 "2009-08-16T04:08:58Z")
> [@Der\_Trihs](#): > > Yes, they ARE indicative of the majority of conservatives. They are the conservative norm, not the fringe. And while there are naturally crazies on the Left, they are neither as numerous, as prominent and not even close to being as powerful as those on the Right. I am a conservative. My extended family are conservative. Many of the people I know are conservative. And yet, I have never met a “birther”. I was shocked when I saw on the news the other day that someone had compared Obama with Hitler. No one I know has ever said Obama was evil. Nor have they done or said any of the other things that the people on this board are ascribing to “conservatives”. From this, there are only two possibilities: 1. You are wrong – the people you are talking about are the fringe and are not remotely representative. 2. It just so happens that that of all of the many conservatives I know and have talked to, not a single one of them thinks anything at all like what the “majority” of “our” political camp does. I find that second one terribly unlikely. I also find it interesting that on a board where the majority of posters are liberal, I have seen thought-out discussion from conservatives several times, but not terribly much from the left. I’m sure you’re all just tired of explaining it over and over, right? I’m also not fond of the term “conservative” for what it’s worth. As someone mentioned, the definition suggests that conservatives would be for preservation of the status quo. I, for one, am NOT fond of the status quo and would like for very many things to change. I DO think that recent change is going in the wrong direction, but you guys all seem to like that part of the status quo, right? ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [August 16, 2009, 4:21am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/68 "2009-08-16T04:21:06Z")
> [@bjbrashier](#): > > I DO think that recent change is going in the wrong direction, but you guys all seem to like that part of the status quo, right? The recent change is already the status quo? ---
**Author:** ![Sateryn76](https://avatars.discourse-cdn.com/v4/letter/s/a88e4f/32.png) [@Sateryn76](https://boards.straightdope.com/u/Sateryn76)\ **Post date:** [August 16, 2009, 4:23am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/69 "2009-08-16T04:23:59Z")
**Sam Stone** , I have found your responses and ideas in these UHC threads to be fantastically well thought out, and I appreciate that you take the time and find the patience to try to explain the economic and non-emotional side of the UHC debate, even in the face of conservative baiting and a clear lack of understanding of basic economic behavior. I agree with you 100% and I note that, in most of these threads, your position is never quite debated. I think that is because there is no response - most on the other side care deeply about the emotional aspects, and very little about the practical aspects. So, just a thanks for that, and… I’m a +1 🙂 ---
**Author:** ![Der\_Trihs](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/der_trihs/32/233_2.png) [@Der\_Trihs](https://boards.straightdope.com/u/Der_Trihs)\ **Post date:** [August 16, 2009, 4:29am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/70 "2009-08-16T04:29:19Z")
> [@bjbrashier](#): > > I am a conservative. My extended family are conservative. Many of the people I know are conservative. And yet, I have never met a “birther”. I was shocked when I saw on the news the other day that someone had compared Obama with Hitler. No one I know has ever said Obama was evil. Nor have they done or said any of the other things that the people on this board are ascribing to “conservatives”. > > From this, there are only two possibilities: > > 1. You are wrong – the people you are talking about are the fringe and are not remotely representative. > 2. It just so happens that that of all of the many conservatives I know and have talked to, not a single one of them thinks anything at all like what the “majority” of “our” political camp does. Last I heard, the polls say most Republicans are birthers. And there’s other possibilities; such as the possibility that you are deceiving yourself about what your fellow conservatives are like. Which leads right into : > [@bjbrashier](#): > > I also find it interesting that on a board where the majority of posters are liberal, I have seen thought-out discussion from conservatives several times, but not terribly much from the left. I’m sure you’re all just tired of explaining it over and over, right? No; you are simply imagining things. > [@bjbrashier](#): > > I’m also not fond of the term “conservative” for what it’s worth. As someone mentioned, the definition suggests that conservatives would be for preservation of the status quo. It’s not and never has been, any more that a “People’s Republic” is about the people. Conservatives have always been more interested in oppressing and exploiting and destroying and killing and warping society in their image than in conserving anything. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [August 16, 2009, 4:30am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/71 "2009-08-16T04:30:08Z")
> [@](#): > > …I think that is because there is no response - most on the other side care deeply about the emotional aspects, and very little about the practical aspects… > > So, just a thanks for that, and… Oh, we’ve noticed that, too, that your arguments are more reasonable and less susceptible to squishy emotionalism. We just prefer to cringe in shame. I’m sorry, didn’t mean to interrupt, you were telling yourself how smart you are? ---
**Author:** ![Sateryn76](https://avatars.discourse-cdn.com/v4/letter/s/a88e4f/32.png) [@Sateryn76](https://boards.straightdope.com/u/Sateryn76)\ **Post date:** [August 16, 2009, 4:40am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/72 "2009-08-16T04:40:44Z")
> [@elucidator](#): > > Oh, we’ve noticed that, too, that your arguments are more reasonable and less susceptible to squishy emotionalism. We just prefer to cringe in shame. > > I’m sorry, didn’t mean to interrupt, you were telling yourself how smart you are? Not at all. I was just pointing out that, in the face of a real, reasoned argument, many people who lean left and participate in these threads simply fall apart. For my cite, just read this thread. Reasonable people can and do disagree. It’s healthy to debate, and the only real way to decide what the best course is. But “won’t somebody please think about children” isn’t a debate, it an appeal to emotion, and does nothing to solve the issue at hand. I find the SD has opened my mind and heart much more than almost anything has in the past ten years or so, and has made me think more about the emotional/liberal side of many arguments, including UHC. I am firmly against UHC and find \*\*Sam Stone’\*\*s position to be extremely reasonable. I would love to hear the other side on this one, but I’m not seeing it here. All I see is completely irrational slamming of conservatives/libertarians, and that’s a crappy way to debate. Post some numbers, demonstrate a moral imperative, reason out an economic argument, I would love it. But this bullshit is tiresome. ---
**Author:** ![bjbrashier](https://avatars.discourse-cdn.com/v4/letter/b/e68b1a/32.png) [@bjbrashier](https://boards.straightdope.com/u/bjbrashier)\ **Post date:** [August 16, 2009, 5:04am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/73 "2009-08-16T05:04:41Z")
> [@Der\_Trihs](#): > > Last I heard, the polls say most Republicans are birthers. Cite? Here’s a simple one from [http://en.wikipedia.org/wiki/Birther:](http://en.wikipedia.org/wiki/Birther:) An opinion poll carried out for Daily Kos by Research 2000 in July 2009 found that 77 percent of Americans believed that Obama was born in the US, while 11 percent didn’t, and 12 percent were unsure. However, Republicans and Southerners were far more likely than other political or demographic groups to doubt that Obama was born in the United States. 58 percent of Republicans either believed that Obama was not born in the US (28 percent) or were not sure (30 percent), with 42 percent believing that he was. So… what you’re saying is that 28% of Republicans constitutes a majority? Especially when the largest group believes the exact opposite? > [@](#): > > No; you are simply imagining things. I don’t understand. What am I imagining? Are people talking about how Obama wasn’t born in the US, and I imagined that they didn’t? > [@](#): > > Conservatives have always been more interested in oppressing and exploiting and destroying and killing and warping society in their image than in conserving anything. From statements like this, from your lack of cites, and from the fact that I haven’t yet seen you make a compelling argument in any thread, I’m inclined to skip over your posts from now on. If you’d like to actually discuss some of the points from, say, Sam, I’d still like to hear it – as long as you refrain from personal attacks and blanket statements. ---
**Author:** ![Obsidian](https://avatars.discourse-cdn.com/v4/letter/o/51bf81/32.png) [@Obsidian](https://boards.straightdope.com/u/Obsidian)\ **Post date:** [August 16, 2009, 10:31am UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/74 "2009-08-16T10:31:04Z")
**Sam** , I’m pretty far to the left, and I think your plan sounds pretty reasonable. I don’t think it sounds much like my understanding of conservative, actually. Reasonable people never get on TV, though, do they? The only conservatives I know personally are of the under-educated, bible thumbing, AmericaFIRST!! variety who quote Rush as an authority with a straight face. So, thanks. I hear a lot that if people had to pay more for going to the doctor, they’d use healthcare more sparingly and reduce costs. As someone who has a chronic, not particularly cheap medical condition she was born with, I have a lot of trouble seeing that issue objectively. (Because god knows I have never had much of a choice). Are there any cites about that theory? I’d be interested in reading them, I hate basing my opinions based just on my gut and my singular experience. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [August 16, 2009, 1:43pm UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/75 "2009-08-16T13:43:02Z")
> [@Sateryn76](#): > > Not at all. I was just pointing out that, in the face of a real, reasoned argument, many people who lean left and participate in these threads simply fall apart. For my cite, just read this thread… I did. I see a pretty ordinary Board argument, some quite reasonable, some not quite so much. You offer us the insight that the arguments you like are sound, intelligent, and well considered. The arguments you don’t like are emotional, unreasonable and perhaps even a bit hysterical. If I read the thread, you offer, I cannot help but see it your way. I have read the thread, and I don’t see it your way. Clear evidence that my thinking processes are flawed, as I somehow managed to avoid the correct conclusion. The evidence offered that this is the correct conclusion is the inescapable logic of your own personal agreement. I don’t think so. No, seriously, I really don’t. ---
**Author:** ![Scylla](https://avatars.discourse-cdn.com/v4/letter/s/a5b964/32.png) [@Scylla](https://boards.straightdope.com/u/Scylla)\ **Post date:** [August 16, 2009, 3:28pm UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/76 "2009-08-16T15:28:29Z")
> [@sqweels](#): > > As I understand it, the problems with our current health care system include: > [ul] > [li]You can lose your coverage if you lose your job or change jobs.[/li][li]Coverage can be unaffordable if it doesn’t come with your job.[/li][li]You can be denied coverage if you have a preexisting condition.[/li][li]Policyholders can be denied coverage by insurers on narrow grounds.[/li][li]The uninsured seek treatment in emergency rooms, the high cost of which is passed along to everyone else, even as the patients are forced into bankruptcy by the bills (correct me if I’m wrong on this).[/li][/ul] > So instead of being purely naysayers, do conservatives have any ideas for addressing these problems? Or do they feel that the tough luck associated with these problems is preferable to the tough luck that would befall people under any alternative plan? Thank you for asking. Some good questions. It breaks down into two areas. Coverage and expense. 1. Losing coverage by losing or changing jobs, and Denial of coverage - COBRA lets you maintain your current coverage for a period of time, so there is a grace period. Insurance is (as all licensed insurance guys learn) considered a “public trust.” This means that for the privilege of serving the market place in a crucial segment, they are required to do a good job. I think reform with an assurance of coverage could fix those three bullet points. I would support that. 2. Expense- I think healthcare is expensive because there is a lot of bureaucracy and because we need tort reform. I know a single OB/GYN in PA with an excellent record in private practice who must pay over $300,000 a year to insure his practice from malpractice. We need to stop using healthcare as a means of subsidizing lawyers, and cut bureaucracy. 3. Emergency rooms. In this area, there are a number of free/ reduced care clinics and a high availability of subsidized preventative healthcare for the needy. Sadly, this gets underutilized as a lot of people just don’t go to the Doctor until they have to go the emergency room. I don’t know a solution to this one, as it’s more of a human nature thing. ---
**Author:** ![bjbrashier](https://avatars.discourse-cdn.com/v4/letter/b/e68b1a/32.png) [@bjbrashier](https://boards.straightdope.com/u/bjbrashier)\ **Post date:** [August 16, 2009, 3:29pm UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/77 "2009-08-16T15:29:25Z")
> [@Fear\_Itself](#): > > The recent change is already the status quo? Sure, but it depends on how you define things. So to start, let me go with a common web search definition ([dictionary.com](http://dictionary.com)): _status quo The existing order of things; present customs, practices, and power relations: “People with money are often content with the status quo.” From Latin, meaning “the state in which.”_ If everything is static, and nothing is moving at all, clearly, this is the status quo. Let me slip in an alalogy here: if you are in a car that is stopped, you are clearly at constant position – a status quo position. But if everything starts moving, things are changing. A new item is not itself part of the status quo until such time as it is accepted an not likely to be changed overmuch. Back to our analogy, the car has started moving. This is no longer status quo, correct? But now let’s constrain the movements. The movements are going only in one direction. In this case, more toward “big government”. In our analogy, the car is moving only forward. We can call this, too, a form of status quo once it has become “constant” enough… it is the constant of the rate of change, the constant of velocity. I assert that a trend toward “big government” is absolutely status quo. Of course there are dips and inconsistencies, but if read like a chart, a move toward bigger government has been pretty constant for many, many years. In fact, here’s a chart showing just this assertion: > **[Analysis of Recent US Total Government Spending](http://www.usgovernmentspending.com/us_20th_century_chart.html)** > > Charts and analysis of recent and historical total US government spending -- including federal, state, and local -- starting in 1900. I also assert that this is bad. Call it “Laffer curve” if you like (though I’m talking about benefit for the people, not income for the government), but I believe that there is a point of optimum government spending (where the people are protected by government as much as needed, but are allowed to keep their money as much as possible, causing the economy to grow and lives to improve), and I think it’s far lower than 40% of the GDP. ---
**Author:** ![bjbrashier](https://avatars.discourse-cdn.com/v4/letter/b/e68b1a/32.png) [@bjbrashier](https://boards.straightdope.com/u/bjbrashier)\ **Post date:** [August 16, 2009, 3:46pm UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/78 "2009-08-16T15:46:03Z")
So I thought I’d add one other thing to this debate: reasonable discourse between different-minded conservatives. I specifically posted my long list of points and reforms BEFORE having read Sam’s. I didn’t want to color my own arguments and thought processes before having a chance to think things through and propose alternatives. I could then look back, see what he wrote, and make changes, which is what I’m doing now. > [@](#): > > 1. End the tax incentives for employer based healthcare. This is not something that should be encouraged. > > 2. Create Health Savings Accounts, which are fully tax deductible. So those with employer-based programs, the employers can give you employer contributions to your HSA, and you still get the same tax deduction. But now your HSA is portable, and people without employer based health care can contribute to their own HSAs and get the same tax deduction. No more distortions favoring those who get health care through employers. > > 3. Create a universal insurance program, for catastrophic costs only. The idea is that no one should go bankrupt or lose their house or be permanently impoverished because of expensive chronic medical problems or because of accidents or sudden serious illness. The way you implement this is to cover all medical bills over a certain amount - in other words, univeral insurance, but with annual deductibles. > > 4. Set up a progressive scale for the deductible based on household income or wealth. What you’re trying to achieve is common utility across all income levels (i.e. the cost of health care should hurt about the same for someone who earns $20,000 per year as someone who earns $2 million per year). This might mean the deductible before catastrophic care kicks in might be $1000 for low income people, and $500,000 for people who earn millions per year. > > 5. Some form of tax credit for health care costs for the truly needy. #1 and #2 together constitute a means to “force” insurance companies to insure people rather than corporations. I think I prefer this method to the method that I proposed. For #3 & #4, I’m actually afraid of the term “universal insurance”. I’m afraid that if we establish it at any level, it will be easily jacked up and abused. I’m not, however, against the idea… but if we were to call it, say, an “uninsured expenditure limit” (which, of course, is also subject to abuse of its own), I believe the purpose is more clear and at least _less likely_ to be abused _as badly._ We can quibble over details, too, of course, but I don’t think our ideas are so different as to be wholly incompatible here. My biggest worry is that Sam’s proposal doesn’t take into account my problem #1, to wit: > [@](#): > > 1. People seem to believe that they are entitled to the best care, no matter the cost and no matter who must pay it. In my opinion, if we don’t do something to solve this problem, it will ruin any solution placed on the table, because it simply has no limit. ---
**Author:** ![brickbacon](https://avatars.discourse-cdn.com/v4/letter/b/898d66/32.png) [@brickbacon](https://boards.straightdope.com/u/brickbacon)\ **Post date:** [August 16, 2009, 4:16pm UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/79 "2009-08-16T16:16:42Z")
> [@bjbrashier](#): > > I’m afraid that there have been enough different suggestions, by enough people, that I’m not sure which ones you’re referring to. Which suggestion(s) would you like further discourse on? And are you more interested in saving taxpayer money, patient money, or what? Either, or both. Let’s look at some of these suggestions. > [@mazinger\_z](#): > > I favor the following: > > 1. Competition across state lines In theory, this might be a compelling option, but in all likelihood, would not produce any welcome, or meaningful [changes](http://newsblogs.chicagotribune.com/triage/2008/10/purchasing-insu.html). > [@](#): > > If the change was implemented, here’s what she (Sandy Praeger, insurance commissioner for Kansas and president of the National Association of Insurance Commissioners) predicts will happen: Insurers will set up shop in states with few regulations and market low-cost policies to people across the country. These policies will offer minimal coverage and appeal primarily to younger consumers. > > “It will be a race to the bottom,” Praeger said, and there will be “very few consumer protections. … You’ll have plans that don’t cover the benefits that people need. … And healthy people are going to buy those less costly plans, because they don’t think they need [the protection].” > > That may be a good deal for young people who don’t have health problems, but it would probably become a bad deal for everyone else, Praeger said. The policies that sell comprehensive coverage would draw a sicker, older customer base, becoming more and more expensive. > > The end result will be a segmenting of the insurance market into the “haves and have nots,” Praeger said. One segment of the market will become more affordable, but the other segment will become less so, disadvantaging those who need coverage most. That’s not even counting the increased costs and confusion from having a national body to regulate all of these companies. > [@mazinger\_z](#): > > 1. Insurance NOT being tied to employment. But isn’t this one of the reasons many people can afford insurance? I agree there are many negative consequences of employer-tied insurance, but they have bargaining power that the individual doesn’t have. > [@mazinger\_z](#): > > 1. HSA for everyone, and a simplification of the tax code to allow this While this certainly addresses a fairness issue, it would cost a lot of money to do this. How do you pay for this? > [@mazinger\_z](#): > > 1. Increase the role of generics and government purchasing of them, to allow patent holders to charge the premiums they need to for investment. I would probably increase the patent life a little, too. All of these things are easier said then done. Plus, increasing the patent life on many drugs would undercut any of the savings from buying more generics (if that is even possible). > [@Sam\_Stone](#): > > 1. End the tax incentives for employer based healthcare. This is not something that should be encouraged. > > 2. Create Health Savings Accounts, which are fully tax deductible. So those with employer-based programs, the employers can give you employer contributions to your HSA, and you still get the same tax deduction. But now your HSA is portable, and people without employer based health care can contribute to their own HSAs and get the same tax deduction. No more distortions favoring those who get health care through employers. There is still a distortion in the sense that your employer is still providing you with health care. Yes, you would not be tied to one particular employer, but the reluctance to leave a job without another lined up that has equivalent contributions is still there. > [@Sam\_Stone](#): > > 1. Create a universal insurance program, for catastrophic costs only. The idea is that no one should go bankrupt or lose their house or be permanently impoverished because of expensive chronic medical problems or because of accidents or sudden serious illness. The way you implement this is to cover all medical bills over a certain amount - in other words, univeral insurance, but with annual deductibles. How would you pay for this? Is it government-run? Is it mandatory? > [@Sam\_Stone](#): > > The first problem is adverse selection. When individuals buy health insurance, the insurance company is at a disadvantage, because of an information asymmetry. You know a lot more about your health than the insurance company does This does not have the effects you mentioned in the real world. The problem with this logic is that they needn’t know an individual’s detailed medical history to effectively price a policy. They can use the aggregate data they have to draw a far clearer picture than an individual can about their own health. Do you know how likely you are to have colon cancer, break your leg, or have a stroke? Your insurance company probably has a better idea than you do. Those are the things that cost lots of money. Not to mention that in the real world, a health insurance company will often just rescind your coverage (and not pay the bills) if they feel the information asymmetry was not in their favor. > [@Sam\_Stone](#): > > So if the insurance company prices insurance at the level for people of average health, people who are above average in health will not buy it. This means the insurance companies are going to get a skewed clientele - people who are more likely than others to need health care. Again, this only makes sense if the average person has confidence that they know how healthy they are, and if people bough insurance and dealt with their health in a rational manner. I contend that none of that is true. I have insurance primarily because I am risk averse, and because I have no confidence that I will always be healthy. I may have confidence I am in good shape, but I don’t know if I’ll get hit by a car tomorrow. > [@Sam\_Stone](#): > > You wind up with a ‘lemon market’. You don’t wind up with a lemon market because the insurance company don’t accept lemons. Even the ones that slip by due to an “information assemtry” get tossed out when they pop up. Why do you think people with chronic illnesses can’t get coverage? If you have evidence to back up this theory, please present it. > [@Sam\_Stone](#): > > The plan above solves this problem by having insurance company’s risk capped. The big worry for them is that they’ll take on a patient with some condition that winds up costing them millions of dollars. Many private plans are already capped. It doesn’t seem to be doing much in the grand scheme of things. The reality is people will need expensive care/procedures, it will cost a shit-ton of money, and someone has to pay for it. Either it will be included in the cost of more routine care, or it will have to be paid for by a catastrophic insurance plan like you mentioned above. The real problem is that most people would not be able to afford both regular insurance, and catastrophic insurance without the government getting involved. If that is the case, what problems have we really solved? Sure, we addressed some fairness issues, and made insurance companies more profitable, but we haven’t really reduced costs at all. > [@Sam\_Stone](#): > > The next problem in health care is the third-party payer problem. Simply put, the price system is broken. People with universal coverage have no incentive to limit their use of the health care system. Most people have some sort of deductible, and a strong desire to not spend all day at a doctor’s office or hospital. There are opportunity costs, particularly when your ability to go to the doctor (your insurance) is contingent upon your continued employment, and presumably, your actually going in to work. With a different pay structure, people might go to the doctor less often, and to the ER more often. They may forgo an HPV vaccine, but may end up with cervical cancer. And yes, I understand that preventative care often does not save money, but I think the human costs are pretty clear. Furthermore, you’ve introduced a model where care is rationed (via ability or desire to pay) in a way that affects the greatest number of people in the majority of circumstances. This is just not politically feasible, nor is it desirable from a psychological standpoint. > [@Sam\_Stone](#): > > Doctors who are paid by a third party and not by the customer have no incentive to control prices or refrain from needless tests. Insurance companies know this, so their solution is an ever-increasing amount of red tape forcing doctors and hospitals to documents every treatment, every little expense. So the system’s management costs go through the roof. The problem is that you assume that doctors are acting in bad faith- that they knowingly order tons of needless tests. That, IMO, is patently false. They probably don’t have the ability to do an effective cost-benefit analysis in every circumstance, but that has more to do with a lack of information, and medical privacy. More importantly, even if you assume that doctors are acting in bad faith, a paying customer is in no better position to bargain or ration care than the insurance company is. All the insurance company risks is profit, while I would be risking my life. I don’t have the bargaining skills, confidence, or the information to effectively rein in overzealous doctors. Do you really think a patient who goes to the ER with knee pain is aware or astute enough to know if she needs an MRI? Do you think she will be able to find the imaging center that offers the best deal? > [@Sam\_Stone](#): > > This plan helps solve this problem by making people responsible for the first level of their own health care costs. Once you connect payments back with customers, they have an incentive to seek out the best value in health care. No they don’t since they have no idea what the best value is; they would just know which treatment has the lowest initial costs. That’s not what value is, particularly wrt health. > [@Sam\_Stone](#): > > The next problem in a public health care system is that you lose ‘early adopters’ - the very rich willing pay large amounts for experimental drugs and new devices. First, almost every conceivable plan, public or otherwise, will not pay for most these treatments. Second, the rich will pay for them regardless because they don’t want to die. ---
**Author:** ![magellan01](https://avatars.discourse-cdn.com/v4/letter/m/45deac/32.png) [@magellan01](https://boards.straightdope.com/u/magellan01)\ **Post date:** [August 16, 2009, 7:51pm UTC](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454/80 "2009-08-16T19:51:24Z")
> [@Der\_Trihs](#): > > Or you could just show up in a thread and say “ **Der Trihs** is wrong for reasons which I will not describe!”. A nicely generic non-argument that would save you having to retype the same empty complaints. But you don’t reply to the non-empty ones. Even after I and other posters in a thread ask you to answer. [Here it is again—Post 216.](http://boards.straightdope.com/sdmb/showthread.php?t=526513&page=5) You were posting in that thread with your (checks forum) usual level of contribution, then ran away. I even gently brought your attention to it in another thread. But you refuse to answer. Odd that, especially in a forum entitled Great Debates that you had already exhibited interest in. [Previous page](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454.md?page=3) [Next page](https://boards.straightdope.com/t/what-sort-of-health-care-reform-do-conservatives-actually-support/506454.md?page=5)