Cowen "Manages" A Health Care Connivance

(And I also posted here.)

I think I’ve made a mistake paying a lot of attention to the ramblings of N. Gregory Mankiw in the Sunday New York Times business section…not because what Mankiw said hasn’t been equal parts of free-market “ownership society” propaganda and political attacks, but because it has diverted me from paying more attention to Tyler Cowen, who is turning out to be at least as guilty of fiction writing in a newspaper that ostensibly prints factual content.

Cowen wrote the following from here yesterday (concerning managed health care)…

We may soon know whether Congress will approve some version of President Obama’s health care plan. No matter what the outcome, there will be an unacknowledged monster lurking in the room: managed care.

The concept embodies many modes of delivering medicine, ranging from the nightmarish bureaucratic encounter to the highly professional clinic. Some forms of managed care — health maintenance organizations like Kaiser Permanente, for example — have been accepted by broad segments of the population.

By the way, concerning Kaiser Permanente, I think the following should be noted from here (particularly that 1971 conversation between President Nixon and John Ehrlichman about how “Edgar Kaiser is running that Permanente thing for profit”…think of where we could be now if that had been snuffed out way back when).

Continuing…

We may not like it, but third parties — the government and insurance companies — won’t be able to pay for all the care that people desire. Yet the aging of the population will ensure that medical costs will spiral. Douglas W. Elmendorf, director of the Congressional Budget Office, has said that the administration’s cost-control proposals do not “reduce the trajectory of federal health spending by a significant amount.”

Maybe, but as noted here, the Senate version of the health care bill is projected by the CBO to cut the deficit by $118 billion over the next ten years.

And here’s more from Cowen…

In addition to the financial burden of Medicare and Medicaid, rising insurance premiums in employer-provided plans are absorbing a large share of what might otherwise be wage increases. That makes us poorer and keeps us from buying safer cars, eating healthier food and investing as productively as we can. Health gains that accompany prosperity are largely invisible, so we tend to neglect them.

Uh, I don’t know the universe in which Cowen resides, but in mine, here’s what happens (and I have a feeling I’m not alone on this). If fortune smiles on me, I get a raise that doesn’t kick in until about the end of the first quarter of the following year. So what happens is that my pay dips after January 1^st because my health insurance premium goes up, and if I’m lucky, the raise makes up for that (hell, I’m lucky to even be working at all, but that’s another story).

Continuing…

Conceived in its broadest form, managed care can be run by the government, as in Britain, or left in the hands of a regulated private sector. Because the United States already has substantial private-sector capacity, and because many Americans are suspicious of government controls, the private route is the most likely option. Individuals would choose among competing providers — and those providers would try to offer the most appealing bundles of services, relative to cost.

I’m not even going to dignify Cowen’s idiotic notion that our health care providers somehow don’t engage in monopolistic practices, which they clearly do. Instead, I’ll link to this post that explains what could very likely be the missed opportunity for the Dems to do something about that (and by the way, there is a link in the Common Dreams post to the White House site that tells us more about how Wellpoint, among others, makes sure there aren’t “competing providers” fighting for their health care dollar).

And finally…

On a national scale, effective managed care will require the right mix of reputation and regulation to enforce provider commitments, and will need some reframing and renaming to make it palatable. It could accurately be called “competitive, choice-based single-payer coverage.” Perhaps there will be a jazzier, less foreboding name.

After reading that paragraph, I now know that Cowen doesn’t know what he’s talking about; as noted here…

Single-payer health insurance collects all medical fees and then pays for all services through a single government (or government-related) source.^[1] In wealthy nations, this kind of publicly-managed health insurance is typically extended to all citizens and legal residents.

Australia's Medicare, Canada's Medicare, the United Kingdom's National Health Service, and Taiwan's National Health Insurance are examples of single-payer universal health care systems. Medicare in the United States is an example of a single-payer system for a specified, limited group of persons within a country.

So Cowen tells us that “private sector capacity” makes our current for-profit model of health care more attractive than a government-run alternative, then introduces language that would easily confuse someone into thinking just such a “public option,” if you will, is something he would recommend?

This column has given me a headache. I’m going to take two aspirin.

And Cowen had damn well better not call me in the morning.