Tuesday, November 19, 2013

Questions not asked

David Theroux sends us to this bizarre Obamacare interview with Nancy Pelosi.  Nevertheless, many writers are trying to be charitable. Here is Gerald Seib, who writes that the ACA we got is the most plausible left-right health care compromise in light of current U.S. politics. The resulting complexity of the compromise is the Achilles heel. Here is Arnold Kling also being charitable.

But it's hard to blot out the Pelosi performance; she has long been one of the ACA's most passionate sponsors and defenders. Note how many times she defends herself by touting the ACA's feature that pre-existing conditions are not grounds for insurers' screening or rejection.

But that's not insurance. I could, for example, have the pre-existing condition of multiple DUI convictions and I expect that this would impact an auto insurer's decision of whether or not to offer me a policy. ACA defenders go repeatedly unchallenged (as in the Pelosi interview) when they tout this great reform feature.

The argument for "reform" and  ACA-type legislation often hinges on the poor U.S. showing ("U.S. Ranks Below 16 Other Rich Countries In Health Report") when health care spending is compared to longevity and other health outcomes.  But the health (and unhealthy) habits of many Americans are not addressed by these approaches.  
"Many people might be surprised to learn, for instance, that for more than half the males who die before age 50, the cause of death has nothing to do with disease — and is therefore not amenable to reduction through medical care."
In all of today's health care discussions, most do even mention this elephant in the room.

Most Americans have their health care paid by third parties (private as well as public insurance).  This explains high levels of demand and treatment and also high prices (and costs). But this links to a bigger problem.  In his very readable and informed discussion, Angus Deaton (The Great Escape, p 146-7) points out that most people do not see that the current arrangement lowers their wages; they do not blame slow growth in take-home pay on how they buy health insurance.

One cannot even imagine an interviewer pitching these questions at the Pelosi we see on the video.