---- Social WelfareTop 10 Things You Should Know About Welfare1. There are two kinds of welfare programs in the United States:
a) Majoritarian politics: nearly everyone benefits, nearly everyone pays
b) Client politics: few people benefit but almost everyone pays
2. Welfare policy in the US is shaped by 3 factors that make it different from what exists in many other nations:
a) Americans have taken a more restrictive view of who is entitled to government assistance (the general view is that public support
should only be given to those who cannot help themselves)
b) America has been slower than other countries to embrace the welfare state
c) We have insisted that the states play a large role in running welfare programs
3,4,5. Major Social Welfare Programs:
-Old Age, Survivors, and Disability Insurance (aka Social Security): monthly payments to retired or disabled people and to surviving
members of their families paid for by a payroll tax on employers and employees [no means test]
-Medicare: Federal government pays for part of the cost of hospital care for retired or disabled people covered by social security
paid for by a payroll tax on employers and employees [no means test]
-Unemployment Insurance: weekly payments to workers who have been laid off and cannot find work paid for by taxes on employers
[no means test]
-Temporary Assistance for Needy Families: payments to needy families with children from black grants to the states [means test]
-Supplemental Security income: cash payments to aged, blind, or disabled people whose income is below a certain amount paid from
general federal revenues [means test]
-Food stamps: vouchers, given to people whose income is below a certain level that can be used to buy food at grocery stores paid from
general federal revenues [means test]
6. Two types of poverty ending programs:
a) Insurance program: a self financing government program based on contributions that provide benefits to unemployed or retired
persons
b) Assistance program: a government run program financed by general income taxes that provides benefits to poor citizens without
requiring contributions from them
7. A means test is a measure to determine that incomes are below a certain level. Means tests showed who was eligible for the assistance programs.
8. The Earned Income Tax Credit is a cash grant to poor parents who were working that provided free school meals, various forms of housing assistance, and certain other benefits.
9. Majoritarian politics involves both the benefits and the costs of a proposed program being widely distributed. The proposal will be adopted if the beneficiaries believe that their benefits will exceed their costs and if political elites believe that it is legitimate for the federal government to adopt the program. Client politics involves the benefits of a proposal going to a relatively small group but the public at large paying. Proposals to benefit clients will pass if the cost to the public at large is not perceived to be great and if the client receiving the benefit is thought to be "deserving".
10. The service strategy (providing training and education) is strongly preferred to an income strategy (giving people money).
The Issue: Universal Health Care
When looking at the nation's welfare policies, the debate over nationalizing health care stands out as a eminent issue There are currently over 45 million Americans who do not have health insurance and millions more who lack sufficient coverage. As health care costs continue to grow, the numbered of uninsured citizens directly increases as well. Since health care premiums are steadily increasing at the rate of 11% each year, many U.S. employers are letting the employee health care plans go. According to the New York Times, globally, the United States ranks last in terms of social welfare equality. They say that “we have the greatest disparity in the quality of care given to richer and poorer citizens” (New York Times). One solution is to enact the globally-used institution of universal health care. Establishing this universal health care would maintain that the government would provide all necessary health services to all of the country's citizens.
What kind of politics are involved around the topic of universal health care?
Among the different types of politics that are involved in the policy making process, majoritarian politics are most closely related to universal health care. In majoritarian politics, a large group bears the cost of the policy and an equally large group receives the benefits. The foundation behind universal health care embodies this basic definition of majoritarian politics. When implementing universal health care, the cost falls to the federal government (one “majority”) and the benefits are given to the citizens (the other “majority”). To the public, the system of universal health care represents a facet of government that would benefit the entire country; every citizen would be given equal care, benefiting the majority of the nation.
The Conservative Stance
The Issue
One of the main tenants of conservatism is spending less money. The fact is that nationalized health care or universal health care does exactly the opposite, it spends money, lots of money. Even without nationalized health care, the United States already spends more money and a higher percent of our GDP(16%) on health care costs than any other country in the world. Our Medicare and Medicaid programs, which cover only a minority of the population, already cost us corpulent amounts of money. Individual state attempts to create a universal healthcare system, such as the Massachusetts Universal Health Care Package, which is already $400 Million dollars over budget, have shown the obvious problem. There really isn't anything the government does inexpensively and well, so why do we think health care will be any different.
The fiscal issue is only one part of the argument. When you simply look at the facts about how many people support a nationalized health care system. You would probably see that around 60% of people support it, however what this really means that 60% of people support a perfect world, fantasy version of nationalized health care. When you look at the number of people who support a nationalized health care system that has waiting lists for non emergency treatments and limited choice of doctors that number gets closer to 30%. Try to find a health care system in this world that solves those two issues—it doesn't exist.
Another issue is that, inevitably, if a nationalized healthcare plan is implemented, quality of healthcare is going to suffer. The government Medicare and Medicaid organizations are already notorious for underpaying hospitals and doctors for their services, which,in itself, is another reason for high health care costs, the hospitals have to make up their money somewhere, and it often falls on the shoulders of private health care. However, the more serious issue here is that with a nationalized healthcare system the government would have a monopoly on paying healthcare providers. In an attempt to keep costs down, you can almost guarantee that government is going to underpay doctors and hospitals for their services, in result, doctor and administrator salaries are going to plummet. The sad consequence of this is that when people have to pay 120,000 dollars to go to medical school, they are going to expect a profession where they make a good living. The point is, that if a doctor starts getting paid like a janitor, your going to see a lot more investment bankers, because those smart and talented people are going to stop paying for medical school and do something where they can make a good living. What to do: Conservative Style
The best solution to the health care problem in America is not to nationalize healthcare. We clearly need to fix the healthcare system we have now, but universal healthcare is not the correct policy to put in place. Health insurance needs to move toward becoming a true insurance plan instead of a reimbursement. A good analogy to how health care currently works in this country is to imagine how much car insurance would cost you, if they paid for your tire alignments and oil changes, what health insurance needs to do is cover the major medical expenses. If people could just pay for their annual physicals or their prescription of Zyrtec, insurance would cost considerably less. Not only that, but people would also make considerably more money too. The reason is that the majority of people recieve their health insurance through their employers. Not only does this cause people to make less money but it also causes, a near complete lack of competition among health insurance providers. If health insurance was a nationally competing market, competition would drive costs down. However, at the current time federal and state mandates regarding what must be included in basic health care plans are keeping this from taking place and making plans more expensive. While there is no doubt a serious healthcare crisis in this country, what we need is for the government to take a step back, and realize that if we want something that is going to work well for everyone, people need to take control of their own healthcare situation. It is hard to argue that competition does not result in a better and cheaper product and I think everyone can agree, that is what the United States and every country needs.
Current Events [Conservative]
How The New Medicine Renders Universal Health Care Impossible
Socialized medicine was a smart idea back when medicine was too stupid to halt infectious epidemics, discourage suicidal lifestyles or discern the perils in killer genes.
Berlin established national health coverage in 1883, soon after Robert Koch identified the bacterial cause of tuberculosis. When your neighbor has TB you're happy to buy him a trip to a hospital, preferably in Aruba. Britain's National Health Service was created in 1948, just as a cure — streptomycin— was becoming widely available. The antibiotic was cheaper than Aruba, and more effective, too.
Washington began subsidizing a large chunk of U.S. health care five years earlier, when the IRS ruled that health benefits supplied by employers weren't taxable income for employees. The poisonous effects of tobacco and diet weren't nailed down until well into the 1950s. A systematic science for isolating and addressing perilous genes has emerged only in the past decade.
But we're now past the days when infectious diseases were the dominant killers, and heart attacks and lung cancer seemed to strike as randomly as germs. In affluent countries, most diseases now originate in human chemistry. The cholera of our times is a stew of molecules, concocted by genes, gluts of cigarettes, beer, ice cream and other delicious consumables, and by whatever attitude problems we might have about eating our peas or taking our pills.
No two human stews are quite the same, however, and the problems they incubate are much less evenhanded than the ones spread by sewage and sneezing neighbors.
Contagion is the melting-pot disease. To be as infectious as they are, germs must use public transit — the common water or air, most typically — and they must target common human chemistry — the bacterial peg must fit neatly into some chemical hole that most of us share. Cholesterol and other human choleras are rooted in our private differences. They disassemble our health, fragment treatment and pull us apart.
In Control
Consider these numbers compiled by Harvard's School of Public Health. Asian-American women have a life expectancy of almost 87 years; African-American men, 69 years. The gap between the highest and lowest life expectancies for U.S. race-county combinations is over 35 years.
Some race-sex-county groups typically die in their 90s, others in their 50s. Some are healthier than the norm in Iceland, Europe and Japan, others sicker than Nicaragua and Uzbekistan. Factoring out wealth, race and access to health insurance doesn't eliminate most of these disparities.
Medicine's principal mission today is to provide antidotes to the unhealthy side of human diversity. Biochemists disassemble glut-and-gene diseases into molecules that can be exposed long before they morph into plaques, clots, tremors, tumors, occluded airwaves, clogged arteries and failed muscles.
Drugs follow. Lipitor tunes our cholesterol, anti-stroke medicines tune our platelets, antidepressants our serotonin and dopamine, heart medicines our angiotensin-converting enzymes, contraceptives our estrogen. Cancer drugs tame or kill our own mutant genes.
Other drugs address deficits: insulin for the underperforming pancreas, clotting factors for bleedy blood, Synthroid for the tired thyroid and cancer-suppressing proteins to lend a hand to tumor-suppressing genes. There's still far more of this in the lab than in the pharmacy, but there's a lot out already, and it's going to keep coming.
While it exposes our differences, the new medicine offers something that the old never could: personal control. Germs are always finding new ways to infect and spread, bad luck invariably figures in who gets hit, and epidemics will forever remain sudden and surprising.
Human chemistry is much more complex, but comparatively slow and stable. Molecule by molecule, medicine is now making it visible, predictable and tractable. Cholesterol can be quite as lethal as cholera, but how much of it you have in your own blood this morning, and what it will do to your heart in 2017, isn't a matter of dumb luck — not any more.
Dumb choice is more like it. Health-careless people tend to be as casual with pills as they are with dessert, so Lipitor only widens the gap between people who generally live informed, disciplined lives and those who don't.
For health-conscious people, skipping the Cherry Garcia may be difficult, but it's cheap, and Lipitor at almost any price is much cheaper than a heart attack. The health-careless skip only the pill, not the ice cream, and end up in desperate need of what helps the least and costs the most.
No one-size, one-price insurance scheme can keep people happy forever on both sides of this ever-widening divide. Aetna can't offer uniform coverage to individuals who face radically different risks, and who know it, too. California can't either.
As they line up in emergency rooms, the health-careless will never know what they're missing. But the health-conscious will gradually come to understand that they are paying for yesterday's medicine, which they don't need any more, and not getting tomorrow's, which they do need. Then, inevitably, they will look for coverage tailored to their own responsible behavior.
If they could, private insurers would respond with policies openly tailored to molecular profiles and priced accordingly. Insurers already do quite a lot of that kind of tailoring indirectly, by letting employment segment and stratify insurance pools along health-discriminatory lines. Any private insurer that fails to push this kind of segmentation as far as it can will end up covering all the heart attacks, while competitors underwrite the low-fat or high-Lipitor diets.
Governments don't face the risks of competition, so they can insure as indiscriminately as taxpayers will allow. Or to similar effect, they can — and do — force private insurers to sell only one-size policies at one-size prices, by way of laws that protect privacy, mandate equal treatment and bar discrimination on the basis of sex, race, disability, pregnancy, age, obesity and much else.
But however it's packaged and peddled, universal health insurance requires steadfast public support — and the political center just can't hold.
\
First, you have the pedestrian problem of costs that rise forever. The passive, clueless and feckless must get ruinously expensive, last-ditch care because they don't show up until it's too late for anything else. The informed and engaged will stay healthy enough to demand better hair, skin and sex along with their Lipitor.
While this is less frantic, desperate medicine, with a quite different price tag, its costs will keep rising, too, for as long as new lifestyles offer new ways to delight our bodies and medicine offers new antidotes to help us survive the pleasure. Vaccines and antibiotics kill their own market by wiping out all the germs. Lipitor just keeps the customer alive to crave more Cherry Garcia.
Then there's the merciless fact of global competition. The cost of health care has a big, direct impact on both the cost of labor and the marginal tax rate. If California defies the new medicine's economics by requiring insurers to ignore everything but age and geography, firms can flee to Texas or Shanghai. Efficient labor markets require efficient health insurance, which will be found only where actuaries are allowed to find out as much as the rest of us can, and craft policies accordingly.
A third, deeper problem is (depending on your politics) either base selfishness or common sense.
The pocketbook-healthy eventually tired of paying for welfare that persistently failed to end poverty; the health-healthy will tire of paying for health care that persistently fails to improve health. However selfless and generous people may be, responsible types eventually despair of trying to cure self-destructive behavior from a distance.
Finally, the new medicine is too hot for even the political Right to handle, and the Left can hardly even acknowledge what it's all about.
To pick just one politically insoluble example among many, scientists have already isolated chemical and genetic links to mental retardation. In due course, they will develop drugs to improve or compensate for genes that help shape intelligence. Then someone will have to decide whether mental acuity, say, is as important as cystic fibrosis, and if so, where insurers must set the IQ cutoff for coverage.
The new medicine can, however, deliver universal health care in the same way that McDonald's delivers universal burgers. Drugs like Lipitor end up very cheap for much the same reason that cholesterol did: There are huge economies of scale in farming cows for milk and fungi for anti-cholesterol drugs, or in brewing up synthetic versions of almost anything.
But it takes a delicate choreography of patent-protected monopoly and cutthroat competition to get the innovation first and the rock-bottom prices later.
At present, the U.S. funds most of the front end. Drug companies introduce most new drugs here first, and affluent Americans pay premium prices while the patents last. Less-affluent Americans, along with public and private insurers in the U.S., Britain, Canada and the rest of the developed world, get a sharply discounted ride on their economic coattails. Three-dollar statins in New York in 1996 get 30-cent statins to London in 2006 and three-cent statins to Kuala Lumpur a few years later.
But governments are impatient, especially when they have promised to supply what they can't possibly afford but can readily seize. In the developing world, the authorities just fail to notice when pirates manufacture knockoffs. Most developed countries have gone halfway there, by instituting a monopoly buyer to bargain against the monopoly patent.
Drug companies, on the other hand, are quite smart enough not to develop three-dollar pills for three-cent buyers. Price-depressing strategies already make it unprofitable to pursue many drugs that treat rare diseases, and drugs for all but the most common diseases earn most of their profit in the U.S. market.
Sickly Illusion
That is the real crisis in health care — not medicine that's too expensive for the poor but medicine that's too expensive for the rich, too expensive ever to get to market at all. Schemes to undercut patents lower the incentive to discover new drugs. They sacrifice long-term global health for short-term political gain. Every last one of them is ice cream today, and never mind about tomorrow.
With almost $30 trillion under management, Wall Street could easily double the couple of trillion it currently has invested in molecular medicine. The fastest way for Washington to deliver more health, more cheaply, to more people would be to unleash that capital by reaffirming patents and stepping out of the way.
On the other side of the pill, molecular medicine can only be propelled by the informed, disciplined consumer. Any scheme to weaken his role will end up doing more harm than good. Foggy promises of one-size, universal care maintain the illusion that the authorities will take good care of everyone. They reaffirm the obsolete and false view that health care begins somewhere out there, not somewhere in here.
Work Cited:
"Health Insurance Costs." National Coalition on Health Care. <http:/www.nchc.org/facts/cost.shtml>.
Langer, Gary. "Health Care Concerns Increase." ABC News. 20 Oct. 2008. <http:abcnews.go.com/sections/living/us/healthcare031020_poll.html>.
Messerli, Joe. "Universal Health Care." Balanced Politics. 25 Sept. 2008. <http:/www.balancedpolitics.org/universal_health_care.htm>.
Pipes, Sally. "5 Myths About Healthcare." Forbes Magazine. 1 Nov. 2008. <http:/www.forbes.com/opinions/2008/10/31/obama-health-care-oped-cx_scp_1101pipe.html>.
Huber, Peter. “How The New Medicine Renders Universal Health Care Impossible.” 26 October 2008. IBD Editorials. 10 November 2008 < http://www.ibdeditorials.com/IBDArticles.aspx?id=278287191931805>
Social WelfareTop 10 Things You Should Know About Welfare1. There are two kinds of welfare programs in the United States:
a) Majoritarian politics: nearly everyone benefits, nearly everyone pays
b) Client politics: few people benefit but almost everyone pays
2. Welfare policy in the US is shaped by 3 factors that make it different from what exists in many other nations:
a) Americans have taken a more restrictive view of who is entitled to government assistance (the general view is that public support
should only be given to those who cannot help themselves)
b) America has been slower than other countries to embrace the welfare state
c) We have insisted that the states play a large role in running welfare programs
3,4,5. Major Social Welfare Programs:
-Old Age, Survivors, and Disability Insurance (aka Social Security): monthly payments to retired or disabled people and to surviving
members of their families paid for by a payroll tax on employers and employees [no means test]
-Medicare: Federal government pays for part of the cost of hospital care for retired or disabled people covered by social security
paid for by a payroll tax on employers and employees [no means test]
-Unemployment Insurance: weekly payments to workers who have been laid off and cannot find work paid for by taxes on employers
[no means test]
-Temporary Assistance for Needy Families: payments to needy families with children from black grants to the states [means test]
-Supplemental Security income: cash payments to aged, blind, or disabled people whose income is below a certain amount paid from
general federal revenues [means test]
-Food stamps: vouchers, given to people whose income is below a certain level that can be used to buy food at grocery stores paid from
general federal revenues [means test]
6. Two types of poverty ending programs:
a) Insurance program: a self financing government program based on contributions that provide benefits to unemployed or retired
persons
b) Assistance program: a government run program financed by general income taxes that provides benefits to poor citizens without
requiring contributions from them
7. A means test is a measure to determine that incomes are below a certain level. Means tests showed who was eligible for the assistance programs.
8. The Earned Income Tax Credit is a cash grant to poor parents who were working that provided free school meals, various forms of housing assistance, and certain other benefits.
9. Majoritarian politics involves both the benefits and the costs of a proposed program being widely distributed. The proposal will be adopted if the beneficiaries believe that their benefits will exceed their costs and if political elites believe that it is legitimate for the federal government to adopt the program. Client politics involves the benefits of a proposal going to a relatively small group but the public at large paying. Proposals to benefit clients will pass if the cost to the public at large is not perceived to be great and if the client receiving the benefit is thought to be "deserving".
10. The service strategy (providing training and education) is strongly preferred to an income strategy (giving people money).
The Issue: Universal Health Care
When looking at the nation's welfare policies, the debate over nationalizing health care stands out as a eminent issue There are currently over 45 million Americans who do not have health insurance and millions more who lack sufficient coverage. As health care costs continue to grow, the numbered of uninsured citizens directly increases as well. Since health care premiums are steadily increasing at the rate of 11% each year, many U.S. employers are letting the employee health care plans go. According to the New York Times, globally, the United States ranks last in terms of social welfare equality. They say that “we have the greatest disparity in the quality of care given to richer and poorer citizens” (New York Times). One solution is to enact the globally-used institution of universal health care. Establishing this universal health care would maintain that the government would provide all necessary health services to all of the country's citizens.
What kind of politics are involved around the topic of universal health care?
Among the different types of politics that are involved in the policy making process, majoritarian politics are most closely related to universal health care. In majoritarian politics, a large group bears the cost of the policy and an equally large group receives the benefits. The foundation behind universal health care embodies this basic definition of majoritarian politics. When implementing universal health care, the cost falls to the federal government (one “majority”) and the benefits are given to the citizens (the other “majority”). To the public, the system of universal health care represents a facet of government that would benefit the entire country; every citizen would be given equal care, benefiting the majority of the nation.
The Conservative Stance
The Issue
One of the main tenants of conservatism is spending less money. The fact is that nationalized health care or universal health care does exactly the opposite, it spends money, lots of money. Even without nationalized health care, the United States already spends more money and a higher percent of our GDP(16%) on health care costs than any other country in the world. Our Medicare and Medicaid programs, which cover only a minority of the population, already cost us corpulent amounts of money. Individual state attempts to create a universal healthcare system, such as the Massachusetts Universal Health Care Package, which is already $400 Million dollars over budget, have shown the obvious problem. There really isn't anything the government does inexpensively and well, so why do we think health care will be any different.
The fiscal issue is only one part of the argument. When you simply look at the facts about how many people support a nationalized health care system. You would probably see that around 60% of people support it, however what this really means that 60% of people support a perfect world, fantasy version of nationalized health care. When you look at the number of people who support a nationalized health care system that has waiting lists for non emergency treatments and limited choice of doctors that number gets closer to 30%. Try to find a health care system in this world that solves those two issues—it doesn't exist.
Another issue is that, inevitably, if a nationalized healthcare plan is implemented, quality of healthcare is going to suffer. The government Medicare and Medicaid organizations are already notorious for underpaying hospitals and doctors for their services, which,in itself, is another reason for high health care costs, the hospitals have to make up their money somewhere, and it often falls on the shoulders of private health care. However, the more serious issue here is that with a nationalized healthcare system the government would have a monopoly on paying healthcare providers. In an attempt to keep costs down, you can almost guarantee that government is going to underpay doctors and hospitals for their services, in result, doctor and administrator salaries are going to plummet. The sad consequence of this is that when people have to pay 120,000 dollars to go to medical school, they are going to expect a profession where they make a good living. The point is, that if a doctor starts getting paid like a janitor, your going to see a lot more investment bankers, because those smart and talented people are going to stop paying for medical school and do something where they can make a good living.
What to do: Conservative Style
The best solution to the health care problem in America is not to nationalize healthcare. We clearly need to fix the healthcare system we have now, but universal healthcare is not the correct policy to put in place. Health insurance needs to move toward becoming a true insurance plan instead of a reimbursement. A good analogy to how health care currently works in this country is to imagine how much car insurance would cost you, if they paid for your tire alignments and oil changes, what health insurance needs to do is cover the major medical expenses. If people could just pay for their annual physicals or their prescription of Zyrtec, insurance would cost considerably less. Not only that, but people would also make considerably more money too. The reason is that the majority of people recieve their health insurance through their employers. Not only does this cause people to make less money but it also causes, a near complete lack of competition among health insurance providers. If health insurance was a nationally competing market, competition would drive costs down. However, at the current time federal and state mandates regarding what must be included in basic health care plans are keeping this from taking place and making plans more expensive. While there is no doubt a serious healthcare crisis in this country, what we need is for the government to take a step back, and realize that if we want something that is going to work well for everyone, people need to take control of their own healthcare situation. It is hard to argue that competition does not result in a better and cheaper product and I think everyone can agree, that is what the United States and every country needs.
Current Events [Conservative]
How The New Medicine Renders Universal Health Care Impossible
Socialized medicine was a smart idea back when medicine was too stupid to halt infectious epidemics, discourage suicidal lifestyles or discern the perils in killer genes.Berlin established national health coverage in 1883, soon after Robert Koch identified the bacterial cause of tuberculosis. When your neighbor has TB you're happy to buy him a trip to a hospital, preferably in Aruba. Britain's National Health Service was created in 1948, just as a cure — streptomycin— was becoming widely available. The antibiotic was cheaper than Aruba, and more effective, too.
Washington began subsidizing a large chunk of U.S. health care five years earlier, when the IRS ruled that health benefits supplied by employers weren't taxable income for employees. The poisonous effects of tobacco and diet weren't nailed down until well into the 1950s. A systematic science for isolating and addressing perilous genes has emerged only in the past decade.
But we're now past the days when infectious diseases were the dominant killers, and heart attacks and lung cancer seemed to strike as randomly as germs. In affluent countries, most diseases now originate in human chemistry. The cholera of our times is a stew of molecules, concocted by genes, gluts of cigarettes, beer, ice cream and other delicious consumables, and by whatever attitude problems we might have about eating our peas or taking our pills.
No two human stews are quite the same, however, and the problems they incubate are much less evenhanded than the ones spread by sewage and sneezing neighbors.
Contagion is the melting-pot disease. To be as infectious as they are, germs must use public transit — the common water or air, most typically — and they must target common human chemistry — the bacterial peg must fit neatly into some chemical hole that most of us share. Cholesterol and other human choleras are rooted in our private differences. They disassemble our health, fragment treatment and pull us apart.
In Control
Consider these numbers compiled by Harvard's School of Public Health. Asian-American women have a life expectancy of almost 87 years; African-American men, 69 years. The gap between the highest and lowest life expectancies for U.S. race-county combinations is over 35 years.
Some race-sex-county groups typically die in their 90s, others in their 50s. Some are healthier than the norm in Iceland, Europe and Japan, others sicker than Nicaragua and Uzbekistan. Factoring out wealth, race and access to health insurance doesn't eliminate most of these disparities.
Medicine's principal mission today is to provide antidotes to the unhealthy side of human diversity. Biochemists disassemble glut-and-gene diseases into molecules that can be exposed long before they morph into plaques, clots, tremors, tumors, occluded airwaves, clogged arteries and failed muscles.
Drugs follow. Lipitor tunes our cholesterol, anti-stroke medicines tune our platelets, antidepressants our serotonin and dopamine, heart medicines our angiotensin-converting enzymes, contraceptives our estrogen. Cancer drugs tame or kill our own mutant genes.
Other drugs address deficits: insulin for the underperforming pancreas, clotting factors for bleedy blood, Synthroid for the tired thyroid and cancer-suppressing proteins to lend a hand to tumor-suppressing genes. There's still far more of this in the lab than in the pharmacy, but there's a lot out already, and it's going to keep coming.
While it exposes our differences, the new medicine offers something that the old never could: personal control. Germs are always finding new ways to infect and spread, bad luck invariably figures in who gets hit, and epidemics will forever remain sudden and surprising.
Human chemistry is much more complex, but comparatively slow and stable. Molecule by molecule, medicine is now making it visible, predictable and tractable. Cholesterol can be quite as lethal as cholera, but how much of it you have in your own blood this morning, and what it will do to your heart in 2017, isn't a matter of dumb luck — not any more.
Dumb choice is more like it. Health-careless people tend to be as casual with pills as they are with dessert, so Lipitor only widens the gap between people who generally live informed, disciplined lives and those who don't.
For health-conscious people, skipping the Cherry Garcia may be difficult, but it's cheap, and Lipitor at almost any price is much cheaper than a heart attack. The health-careless skip only the pill, not the ice cream, and end up in desperate need of what helps the least and costs the most.
No one-size, one-price insurance scheme can keep people happy forever on both sides of this ever-widening divide. Aetna can't offer uniform coverage to individuals who face radically different risks, and who know it, too. California can't either.
As they line up in emergency rooms, the health-careless will never know what they're missing. But the health-conscious will gradually come to understand that they are paying for yesterday's medicine, which they don't need any more, and not getting tomorrow's, which they do need. Then, inevitably, they will look for coverage tailored to their own responsible behavior.
If they could, private insurers would respond with policies openly tailored to molecular profiles and priced accordingly. Insurers already do quite a lot of that kind of tailoring indirectly, by letting employment segment and stratify insurance pools along health-discriminatory lines. Any private insurer that fails to push this kind of segmentation as far as it can will end up covering all the heart attacks, while competitors underwrite the low-fat or high-Lipitor diets.
Governments don't face the risks of competition, so they can insure as indiscriminately as taxpayers will allow. Or to similar effect, they can — and do — force private insurers to sell only one-size policies at one-size prices, by way of laws that protect privacy, mandate equal treatment and bar discrimination on the basis of sex, race, disability, pregnancy, age, obesity and much else.
But however it's packaged and peddled, universal health insurance requires steadfast public support — and the political center just can't hold.
\
First, you have the pedestrian problem of costs that rise forever. The passive, clueless and feckless must get ruinously expensive, last-ditch care because they don't show up until it's too late for anything else. The informed and engaged will stay healthy enough to demand better hair, skin and sex along with their Lipitor.
While this is less frantic, desperate medicine, with a quite different price tag, its costs will keep rising, too, for as long as new lifestyles offer new ways to delight our bodies and medicine offers new antidotes to help us survive the pleasure. Vaccines and antibiotics kill their own market by wiping out all the germs. Lipitor just keeps the customer alive to crave more Cherry Garcia.
Then there's the merciless fact of global competition. The cost of health care has a big, direct impact on both the cost of labor and the marginal tax rate. If California defies the new medicine's economics by requiring insurers to ignore everything but age and geography, firms can flee to Texas or Shanghai. Efficient labor markets require efficient health insurance, which will be found only where actuaries are allowed to find out as much as the rest of us can, and craft policies accordingly.
A third, deeper problem is (depending on your politics) either base selfishness or common sense.
The pocketbook-healthy eventually tired of paying for welfare that persistently failed to end poverty; the health-healthy will tire of paying for health care that persistently fails to improve health. However selfless and generous people may be, responsible types eventually despair of trying to cure self-destructive behavior from a distance.
Finally, the new medicine is too hot for even the political Right to handle, and the Left can hardly even acknowledge what it's all about.
To pick just one politically insoluble example among many, scientists have already isolated chemical and genetic links to mental retardation. In due course, they will develop drugs to improve or compensate for genes that help shape intelligence. Then someone will have to decide whether mental acuity, say, is as important as cystic fibrosis, and if so, where insurers must set the IQ cutoff for coverage.
The new medicine can, however, deliver universal health care in the same way that McDonald's delivers universal burgers. Drugs like Lipitor end up very cheap for much the same reason that cholesterol did: There are huge economies of scale in farming cows for milk and fungi for anti-cholesterol drugs, or in brewing up synthetic versions of almost anything.
But it takes a delicate choreography of patent-protected monopoly and cutthroat competition to get the innovation first and the rock-bottom prices later.
At present, the U.S. funds most of the front end. Drug companies introduce most new drugs here first, and affluent Americans pay premium prices while the patents last. Less-affluent Americans, along with public and private insurers in the U.S., Britain, Canada and the rest of the developed world, get a sharply discounted ride on their economic coattails. Three-dollar statins in New York in 1996 get 30-cent statins to London in 2006 and three-cent statins to Kuala Lumpur a few years later.
But governments are impatient, especially when they have promised to supply what they can't possibly afford but can readily seize. In the developing world, the authorities just fail to notice when pirates manufacture knockoffs. Most developed countries have gone halfway there, by instituting a monopoly buyer to bargain against the monopoly patent.
Drug companies, on the other hand, are quite smart enough not to develop three-dollar pills for three-cent buyers. Price-depressing strategies already make it unprofitable to pursue many drugs that treat rare diseases, and drugs for all but the most common diseases earn most of their profit in the U.S. market.
Sickly Illusion
That is the real crisis in health care — not medicine that's too expensive for the poor but medicine that's too expensive for the rich, too expensive ever to get to market at all. Schemes to undercut patents lower the incentive to discover new drugs. They sacrifice long-term global health for short-term political gain. Every last one of them is ice cream today, and never mind about tomorrow.
With almost $30 trillion under management, Wall Street could easily double the couple of trillion it currently has invested in molecular medicine. The fastest way for Washington to deliver more health, more cheaply, to more people would be to unleash that capital by reaffirming patents and stepping out of the way.
On the other side of the pill, molecular medicine can only be propelled by the informed, disciplined consumer. Any scheme to weaken his role will end up doing more harm than good. Foggy promises of one-size, universal care maintain the illusion that the authorities will take good care of everyone. They reaffirm the obsolete and false view that health care begins somewhere out there, not somewhere in here.
Work Cited:
"Health Insurance Costs." National Coalition on Health Care. <http:/www.nchc.org/facts/cost.shtml>.
Langer, Gary. "Health Care Concerns Increase." ABC News. 20 Oct. 2008. <http:abcnews.go.com/sections/living/us/healthcare031020_poll.html>.
Messerli, Joe. "Universal Health Care." Balanced Politics. 25 Sept. 2008. <http:/www.balancedpolitics.org/universal_health_care.htm>.
Pipes, Sally. "5 Myths About Healthcare." Forbes Magazine. 1 Nov. 2008. <http:/www.forbes.com/opinions/2008/10/31/obama-health-care-oped-cx_scp_1101pipe.html>.
Huber, Peter. “How The New Medicine Renders Universal Health Care Impossible.” 26 October 2008. IBD Editorials. 10 November 2008 < http://www.ibdeditorials.com/IBDArticles.aspx?id=278287191931805>
Political Cartoon [Conservative]