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Any answers to SmadaNek's points in his blog?

by Right of Center on June 02 at 12:50 PM EST

talking past each other

I appreciate Smadanek's energetic criticism, but I'm afraid I can't respond to each specific claim because we would really just be talking past each other.  Let me illustrate with a few examples.

Smadanek starts off his post by claiming that the state isn't constitutionally supposed to provide health care, but it may runs afoul of equal protection clauses if it doesn't provide health care to 100% of New Jerseyans.  That's just a strange position, because the state of New Jersey already provides health care access to some fraction of the population.  Is the state currently operating in violation of its constitution?  Why hasn't this been raised in courts and struck down?  All in all, I find this a strange criticism, but it's not really a criticism of our plan, it's more of a philosophical dispute that the state has any role in providing access to health care at all.  I respect this philosophical difference, but it's just that.

Smadanek goes on to assume that the medical market is a perfect market with supply responding perfectly to demand.  Anyone involved in health policy knows that health care is one of the most heavily regulated industries there is, precisely because it deals with life and death.  We do not turn away people from the emergency room, even if they cannot pay.  Now, Smadanek may wish to see people turned away from the emergency room so that the market functions perfectly.  But this is a philosophical difference, not a technical one.

Smadanek also won't believe, no matter what the numbers, that reorganizing the system could save money.

Changing the question is intended to distract from the basic fact that this will cost more than you are claiming. (An aside: The government has never "asked" me for more money, it has simply confiscated it, under threat of prosecution, from my weekly paycheck.)

Curtis described why we think the plan is accurate in its cost estimates, which was a response to Smadanek's initial queries.  Smadanek simply doesn't believe it - he asserts that it is a "basic fact" that "this will cost more than you are claiming".  To him it is a fact that our numbers are wrong even before he asks the question.  I appreciate the academic exercise of putting us through an impossibly cynical wringer, but he has already precluded a satisfying answer.

The rest of his points fall along similar lines.

Anyway, here are some places where we think we can control costs:

  • Approx. 20% of medical tests are ordered because previous results cannot be found.

  • 3% to 10% of premium costs are lost to fraud.

  • NJ has lowest generic utilization in the country; taxpayers, individuals with drug coverage, and individuals without drug coverage pay high costs.

  • At more than $13,000 per family, New Jersey's health care premiums are 11 percent higher than the national average.  The average premium for New Jersey families is $1,682 dollars more than in Pennsylvania and $1,021 more than New York.  

Anyway, I hope this answers why I haven't really gone into depth and answered every point in Smadanek's response to Curtis.  I appreciate Smadanek's queries, and I read his blog, which is why I encouraged Curtis to respond in the first place.  He just doesn't believe our sourced numbers because ideologically he's inclined to think the health care system should be entirely privatized.  That's fine, but I can't really convince him that a solution where the state organizes its health care system along more rational lines will make sense.  He just can't believe that our numbers work even though they do.  Bulk discounts, for instance, are not rocket science, and they work.  So does qualifying for more Federal money.  

by Matt Stoller on June 02 at 6:09 PM EST
[ Parent ]

Response to the response to the response


Thanks for reading my blog.  Despite our disagreements, which are fundamental and deep, I appreciate the fact that you take the time to read what I have to say.

That said, you have misrepresented me in your reply.   What I said regarding constitutionality was (emphasis added)

The state's Constitution grants no such power or responsibility to the government. Even if it did, enacting law or regulation to provide health care access to anything less than 100% of the citizens would probably run afoul of equal protection.

My discussion of supply and demand did not state that medical care was a perfect market.  I made a generalization, and you took it to an absurd extreme.  To imply that I would want people turned away from emergency rooms because of that generalization is a cheap shot.

As to reorganization, what I will not believe is that inserting more government into the equation will reduce costs.  Government does not actually provide health care in most cases, it just moves money around while imposing an administrative cost.  You said, "I can't really convince him that a solution where the state organizes its health care system along more rational lines will make sense," and you are correct.  I believe that government in general is incapable of organizing anything along rational lines -- look at federal procurement regulations or the tax code for prime examples.

by SmadaNek on June 02 at 10:55 PM EST
[ Parent ]


Government does not actually provide health care in most cases, it just moves money around while imposing an administrative cost.

As opposed to private corporations?  Who move money around and impose administrative costs?!  Guess where administrative costs come from?  Salaries of the people who are administrating.

The reason most people Don't work for the state is because the salaries are less than in private industry.

Really this arguement about Big Government making things more expensive reeks of Methane Sulfide Gases which typically fumagate cattle houses.

Smadanek, its simple let's use words you free marketeers would find a bit friendlier.

Collective Bargaining Agreements.  That's how you bring the prices of drugs down!  

The price differs 100's of times between generic and brand name drugs.  

On those two points alone you save a crapload of money.  

Media In Trouble

by media in trouble on June 03 at 3:37 PM EST
[ Parent ]


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