Posted by
Yubaduck on Thursday, August 09, 2007 5:06:48 AM
Basically the rift between Conservative and Liberal comes down to a single philosophical debating point:
Is the answer to a societies needs best found in government solutions or in individual solutions?
A liberal would say that people cannot be trusted to know what is best for them, and that life's needs must be provided for them. Some liberals, while thinking this would put it into less offensive terms and say that while people know what is best , and have an idea how to get it, the world is stacked to favor some people over others and this societal or institutional unfairness must be addressed and rectified by the government.
A conservative would say that people will never take responsibility for their own well being when they are guaranteed by the government that they will not fail. They would say that people have the right to pursue happiness, and with this right comes the ability to either succeed or fail and pay the consequences of that failure. They would also say that government involvement in markets both dampens the rewards of ingenuity and creativity, and protects the foolish and the weak and acts as a disincentive to them to produce anything of value.
And so we have at the two extreme ends of a political spectrum, the State Economy, in which all aspects of life deemed essential, and all producers of those aspects are controlled by state agencies and bureocrats, and the Laissez Faire Economy in which all aspects of life with the exception of law enforcement and international relations are free to rise and fall as market forces dictate. Reality in almost all cases lies somewhere in between these two extremes. I will in this case, use Health Care as an example commodity, and in later posts, use other issues.
Health Care: In the old days, a Doctor trained in medicine and then went out and set up a practice. He had complete autonomy whether to accept or deny patients, how complicated of procedures to offer, how and for what to accept payment, and countless other decisions. Most Doctors under this system made little more or even less than their less educated neighbors who farmed or worked in industry because they were neighbors with their patients and had empathy more than business sense. With better transportation came more consumer choices, and with more consumers to choose between came more options for Doctors to accept, deny, or refer patients, and also came higher prices. With the massive technoligical advances of the 19th and 20th century also came an unparalleled ability to extend life in ways unimagined before. But all of these ways cost money, and soon there came a vast difference in ability to pay for health care, and so came the idea of insurance....you pay a company when you are healthy, and they pay for your care when you need it. If you drop dead suddenly with no precursors, they make a huge profit off of you. If you contract a terminal and long term illness, your care far exceeds what you paid them. In the end, in theory, it all balances out. Over time, health insurance came to be associated with companies people worked for rather than bought by individuals. Benefits like health care were an incentive for a person to remain in the employ of a company, especially if they had family members with expensive needs. So Health Care, which had once been a complete free market commodity, became something else (I am not sure what you would call this, some of you economic experts can help me out). As procedures and medicines grew in expense, it became less and less easy for an individual to pay for them. And so they became more and more dependent on Insurance. And Insurance became more and more expensive, to the point where some people pay as much for insurance as they do for a house. As the labor market changes, and people are far less likely to work for one company for 40+ years, tying insurance to work also became problematic because if you switch jobs, you may not qualify for insurance at the new place. And so, in the 1960's, recognizing that some people who were covered their whole working lives had no coverage in retirement, and that others were basically indigent and either died for lack of health care, or got it and then never paid, the Government produced Medicare for its older citizens and Medicaid for its indigent younger citizens. (definitely a liberal solution). Since the 60's introduction of Government into the system, costs have skyrocketed, and whole new classes of people are uncovered by insurance and the cost of Health Care without insurance has risen beyond the personal reach of almost everyone. And so there is a "health care crisis". What is the liberal solution, and what is the conservative solution?
Liberals, not trusting profit seeking insurance companies, would prefer to socialize the whole thing. What this means is, that everyone pays taxes to the Government that it then sets aside theoretically for health care costs. When a person gets sick, they go to the doctor, the doctor sends a bill tot he government and the government pays. Everyone is covered every time they are sick, and we all live happily ever after.
Conservatives, not trusting government, hate this idea. They would prefer the 19th century system where everyone pays their own costs individually, or individually buys insurance. They see the government involvement in the marketplace of health care as a source of waste, legal and bureocratic red tape, and corruption. If a person chooses not to be insured, or decides they "can't afford it", they made the decision, they will have to live with it.
So present these two options to the voters, which will they choose? Presented this way, people will almost always choose the "free lunch". So conservative politicians abandon this conservative philosophy, on a case by case basis, and become liberals, but cheaper.
This is where we are now. Republicans back prescription drug benefits for seniors, just a cheaper version than Democrats. Republicans want to scale back Medicare, but not eliminate it, same with Medicaid. In their only true conservative idea, Republicans want to ease restrictions on Drug companies and Doctors to do their jobs without fear of legal attacks, thus cutting malpractice insurance, and thus cutting doctor costs. Republicans lose on the health care issue, unless they can show the failure of the Democratic model and present a successful model of their own.
Showing the failure of this model is easy. In every nation where there is a socialized system, there is an extreme supply issue. Under our current system, there is a problem, but the market corrects itself. This correction is expensive, but possible. Here is an example:
My wife recently had a baby. Another woman we know did as well. For my wife, all of the bills have now come in. The cost for having a baby is around $14,000 when you include medicines, hospital stays, doctor fees, meals, and all the rest. Our insurance covers about 8,000. we are responsible for about 1,800 and because my wife works for the hospital, as part of her benefits, the hospital dropped the rest. So of the 14,000 charged, the medical professionals and facility get about 9,800, "losing" about 4,200. The woman we know is a single mom who works but is "low income" and is on California Healthy Families. Of the same 14,000 cost, the State pays about 6,000, she pays 250, and the hospital is required to drop the rest. If the woman were illegal or on federal medicaid, I have no idea what the hospital would get. The point is, that this "loss" is not simply eaten by the hospital, they pass on a portion of it to every mother admitted.
Lets say 100 women have babies, and the cost of these babies is 10,000 each, that is a cost to the hospital of 1 million.
If 20 of these women are on Healthy Families which pays about 45%, the hospital recieves 90,000 of their 200,000, and passes the other 110,000 on to the other 80 women, meaning they charge them an extra 1,375 so that all the costs are covered.
If another 20 women are free for various reasons, , their 200,000 is also divided up, meaning the hospital has recieved 90,000 out of 400,000, and 310,000 divided up among the 60 women remaining is 5,167 added to each womans bill who pays. So we have 60 women paying 15,670, 20 paying 4,500 and 20 paying nothing.
This is one of the reasons for the outrageous cost of healthcare. Also, Insurance companies who are big enough can negotiate certain rates. Lets say in the above example that Blue Cross tells the hospital we will pay up to 12,000, if you do not accept this, we will send our patients to another hospital. Lets say that of the 100 women above, 40 are on Blue Cross. 40 at 12,000 each is 480,000 plus the 90,000 for the 20 Healthy Families and 20 indigent women, meaning to meet costs, the hospital must recieve from the last 20 women 430,000 or 21,500 per woman. this is what individuals and smaller insurance companies are forced to pay.
So how does the Government system work? Remember, Healthy Families was willing to pay 4,500 per delivery. So the hospital gets 450,000 to cover 1 million in costs. So the hospital goes under, cuts staff, cuts patient care, or cuts wages to its staff. If enough hospitals go under, the state feels obligated to take over the rest. It then says to them we say a birth should cost 4,500, so all medical staff makes 45% of previous salary. So why would a doctor go through 8-10 years of school, internships, medical boards, sleepless nights of studying, massive debt and a strained family life, just to make the same as a High School Principal who has half the education, more regular hours, and tenure? Answer is they wouldn't. So you have a shortage of medical personnel, so you have a rationing of care, and we see this in every country with socialized medicine.
Easy to show the liberal failure, but that is just half the job. So what would a true conservative solution look like?
People are off of their parents health care at the age of 18 (this is somewhat negotiable.)
At that age, they are provided with choices:
1) They can have no insurance understanding that any emergency care they recieve is fully their own responsibility.
2) They can purchase insurance. I believe that Insurance should be like life insurance. You negotiate a rate, and pay that rate for a certain predetermined number of years. Lets say you choose a plan with very high deductibles and copays because you think you will rarely get sick. Maybe this plan costs you $50 a month. If you develop diabetes or skin cancer within the 20-30 years, they pay little because of the risk you took, but if you chose the 120 a month plan, they still cover you when these diseases pop up, because that is the risk they take. But at the end of the 20-30 year term, they can say pay more or be dropped.
3) They can purchase cooperative insurance. This is the idea behind work insurance. A company charges less per person because of the 50 employees, maybe only 2-3 are high risk, and the rest of the premiums offset the cost. I would like to see this co-op insurance offered independent of work. This way, if you are self employed or change jobs, you keep your insurance. If workplaces are not involved in insurance decisions, they can pay more, or choose to provide their product for less.
A conservative solution would remove all but the most indigent from government systems. This would allow the hospital to recieve their costs from more patients, thus lowering costs per patient. Caps on malpractice suits, punishment for frivolous suits, and reduced red tape would also lower costs considerably. Unrelated, but useful, Bush wanted to allow people to deduct from their wages into tax free medical accounts. These would be like 401K's where you put $50 a month into an account for 30 years, then when you have a triple bypass at the age of 55, you have 18,000 plus interest in an account to pay for it. Right now, there is no incentive to save for medical costs because of the "free" health care provided by the government or employers.
So how do Conservatives promote the idea of a conservative solution? After all, most people like the "free lunch" as presented by Michael Moore. When my in laws were here for the birth, my mother in law, typically very conservative, was raving about Sicko, and the idea of socialized medicine. The thought that its all taken care of for you is very appealing, even to some nominal conservatives, and that is what w