Fear of the chocolate eclair Nazis, Pt. 2 by mattsteinglass
July 29, 2009, 9:47 pm
Filed under: Conservatism, Health

Okay, Andrew Sullivan has now called Megan’s post a “must-read“, and I’ve heard from another source that the conservative-libertarian crowed really seems to like it. I have to reiterate: this is ridiculous.

What is the catastrophic outcome Megan is afraid of? It is this: that the government will start trying harder to help fat people lose weight. Seriously. This is the dystopian example that she provides of how increased government involvement in the health market will “curtail future freedoms”.

She provides two examples of the kinds of programs she’s talking about. One is a hypothetical government behavior change communication program for overweight people, which she argues will not work. Again: why is she afraid that the government, when it comes under pressure to save money on health care, will thus be driven to spend money on a program that does not work? The other program would be hypothetical government coercion not to eat fattening food. Again: every single advanced country in the world except for the US has government-supported universal coverage. There is not a single case of a government that forcibly restricts the food consumed by citizens. This is ludicrous, on a Jim DeMint level.

The other harm Megan claims from universal health insurance is that it will destroy innovation in the health care sector. How? Well, “in the absence of a robust private US market” — what? Hold it right there. Who proposed getting rid of private health insurance in the US? Exactly no one. Certainly not the health care reform bills currently in Congress. And if they did, there would still be the private health insurance market in France, the private health insurance market in the Netherlands, the private health insurance market in Germany, and so on, to pick up the slack. In each of those three countries, private health insurance covers almost the exact same percentage of total health spending outlays as in the US! Most countries in the world that have universal health coverage have robust private insurance markets. What health care universe does Megan inhabit?

Even if the above mistakes weren’t enough, there is simply no evidence that innovation in effective health care is mainly driven by the private US market. And when Megan says there’s a crisis in pharmaceuticals innovation going on these days, she’s right. The crisis is this: private pharmaceuticals companies aren’t producing, or even working on, a significant number of new drugs for major health problems. No new lines of antibiotics to fight antibiotic-resistant strains of TB and other bacteria. No new anti-malaria drugs. And so on. The pharmaceuticals companies claim it’s because patent terms are too short. Whatever. If the private US insurance market is supposed to be driving innovation in pharmaceuticals, then the private US insurance market is failing.

Look, Megan’s post doesn’t make any sense. That conservatives of a free-market bent read through it and think that it does shows that they have been conditioned by 30 years of Friedmanite language to react positively to a particular ideological style of rhetoric and set of catchphrases even when those catchphrases have been assembled to form a proposition that is incoherent.


3 Comments so far
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No offense, Matt, but you’re seizing on one sentence to invalidate the entire post. I don’t want deeper state involvement in the health care sector because a) I think it will destroy innovation and b) I don’t want further coercive intrusion of the state into some very private areas of people’s lives, an argument to which you might be more sympathetic if you consider what would happen to abortion rights under Republican administrations. You can call me a nonsensical libertarian ideologue, and I can call you a reading-comprehension challenged authoritarian nut, but this will not actually advance the argument. The liberals who are completely enraged by the piece have overwhelmingly demonstrated that they feel unable to emotionally engage with anyone who doesn’t share their particular set of priorities. That’s not our problem; it’s yours, just like when a liberal writes a defense of national health care, and wingnuts start fulminating about how they’re just too stupid to understand that PROPERTY RIGHTS ARE SACRED, and also THEY HATE FREEDOM! the issue is not that the liberals aren’t making sense.

Comment by Megan McArdle

You’re right, on the tone. I apologize. I shouldn’t write that late at night.

On the substance: it’s also not true that the post was incoherent. What it was, was irrelevant to the actual issue of health insurance, either as it is being addressed in the US today, or as it is being addressed anywhere else in the world. If a single-payer system were being seriously proposed in the US, then your post would be relevant to the issue at hand, and we’d be arguing about why it just isn’t true that single-payer would entail these harms. But with the US government already paying 40%+ of the medical bills in the US, a percentage just slightly lower than the 40%+ that’s paid by the government in France, the Netherlands, etc., and the US currently proposing a system that’s basically like the Netherlands, you’re just not addressing what is actually happening here. And what’s enraging to liberals is that you’re far too smart not to understand that you’re being misleading when you write “in the absence of a robust US private insurance market”. You’ve got to know that the proposals that have gone forward protect the US private insurance market precisely out of deference to the concerns of people like yourself, with whom we disagree fundamentally about so many things, but who we’ve recognized have the right not to be ridden roughshod over. Surely you see why this is infuriating.

Comment by mattsteinglass

@Matt – I have to agree with you. Megan really doesn’t seem to have much supporting a lot of her argument. Take this section:

“Agencies like Britain’s NICE are a case in point. As long as people don’t know that there are cancer treatments they’re not getting, they’re happy. Once they find out, satisfaction plunges. But the reason that people in Britain know about things like herceptin for early stage breast cancer is a robust private market in the US that experiments with this sort of thing.”

The actual reason is because Britain’s private medical service providers (like BUPA, for example) are willing to offer these treatments, and because (in the specific case of Herceptin) the drug was available from the National Health Service in some areas of the country but not in others thus leading to a so-called ‘postcode lottery’. Herceptin itself was developed by Genentech, now owned by Swiss conglomerate Hoffman-La Roche, in co-operation with UCLA – in fact most of the development work of the drug was done by UCLA, not Genentech.

The article seems firstly to presume that all competition will be eliminated from the system by the introduction of minimum universal healthcare (why?) and that this will, of course, destroy pharmaceutical innovation (although nobody is talking about nationalising the pharmaceuticals companies). Why is it assumed that the pharmaceuticals developers and the insurance providers are one and the same? The leap first from this pseudo-reasoning to an odd section complaining of the imposition of ‘elite’ cultural values and then onwards to ground zero (of all places) is simply bizarre.

Comment by FOARP

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