Q&A With Another Mendacious Hack

Over at Townhall.com, conservative performance artist and unintentional satirist Dennis Prager has a column entitled 10 Questions for Supporters of 'ObamaCare', that reads like a primer for dishonest right wing talking points.

Mr. Prager's "10 questions" are actually more like fifty, since he makes multiple queries in each one, but since his article encompasses many of the most popular assaults on President Obama's efforts to reform health care coverage, I thought it would be worthwhile to address them. What follows, then, is my own primer for responding to many of the major falsehoods propagated by opponents of a public health insurance option:

Question 1:
President Barack Obama repeatedly tells us that one reason national health care is needed is that we can no longer afford to pay for Medicare and Medicaid. But if Medicare and Medicaid are fiscally insolvent and gradually bankrupting our society, why is a government takeover of medical care for the rest of society a good idea? What large-scale government program has not eventually spiraled out of control, let alone stayed within its projected budget? Why should anyone believe that nationalizing health care would create the first major government program to "pay for itself," let alone get smaller rather than larger over time? Why not simply see how the Democrats can reform Medicare and Medicaid before nationalizing much of the rest of health care?

Answer:
No one - with the exception of dishonest Republican hacks - is talking about nationalizing health care. The issue on the table is a public option for health care COVERAGE that would compete against private plans, not government control over the practice of medicine.


Question 2:
President Obama reiterated this past week that "no insurance company will be allowed to deny you coverage because of a pre-existing medical condition." This is an oft-repeated goal of the president's and the Democrats' health care plan. But if any individual can buy health insurance at any time, why would anyone buy health insurance while healthy? Why would I not simply wait until I got sick or injured to buy the insurance? If auto insurance were purchasable once one got into an accident, why would anyone purchase auto insurance before an accident? Will the Democrats next demand that life insurance companies sell life insurance to the terminally ill? The whole point of insurance is that the healthy buy it and thereby provide the funds to pay for the sick. Demanding that insurance companies provide insurance to everyone at any time spells the end of the concept of insurance. And if the answer is that the government will now make it illegal not to buy insurance, how will that be enforced? How will the government check on 300 million people?

Answer:
The legislation currently being crafted contains a mandate requiring all citizens to have health insurance. There will certainly be people who fail to comply with the mandate for coverage - just as there are people who fail to pay their taxes - but a well-crafted plan will account for some level of non-compliance. Increasing the pool of people paying into insurance in no way "spells the end of the concept of insurance"; just ask the citizens of pretty much every other developed nation on the planet.


Question 3:
Why do supporters of nationalized medicine so often substitute the word "care" for the word "insurance?" it is patently untrue that millions of Americans do not receive health care. Millions of Americans do not have health insurance but virtually every American (and non-American on American soil) receives health care.

Answer:
I don't know, but I bet it is not for the reason that Mr. Prager is conflating "coverage" and "care," which is clearly to create the impression that the current debate over health care reform could lead to government interference in the doctor-patient relationship rather than changing how we pay for treatment. In any case, this isn't germane to the debate at hand; again, no one is advocating nationalizing the practice of medicine.


Question 4:
No one denies that in order to come close to staying within its budget health care will be rationed. But what is the moral justification of having the state decide what medical care to ration?

Answer:
Simply put, there is no moral justification for the state rationing health care, just as there is no moral justification for rationing by private companies, which is what we have today. Neither governments nor corporations are required to justify their actions morally; just legally and ethically.


Question 5:
According to Dr. David Gratzer, health care specialist at the Manhattan Institute, "While 20 years ago pharmaceuticals were largely developed in Europe, European price controls made drug development an American enterprise. Fifteen of the 20 top-selling drugs worldwide this year were birthed in the United States." Given how many lives - in America and throughout the world – American pharmaceutical companies save, and given how expensive it is to develop any new drug, will the price controls on drugs envisaged in the Democrats' bill improve or impair Americans' health?

Answer:
First, in the modern era of direct-to-consumer marketing of drugs, it remains an open question as to whether sales of a given pharmaceutical correlate to efficacy. (It is also an open question - although much, much less of one - whether one should take at face value the word of a man who shamelessly shills for a conservative think tank, and who has been publicly humiliated for making misleading statements before Congress.) Second, just because pharmaceutical companies might set up shop somewhere besides the United States, that in no way means that Americans will be denied access to the drugs these relocated (or foreign) companies develop. As long as there is demand for treatment, someone will meet that demand. Finally, this is a question of pharmaceutical industry economics, and it has little to do with the need to reform health care coverage.


Question 6:
Do you really believe that private insurance could survive a "public option"? Or is this really a cover for the ideal of single-payer medical care? How could a private insurance company survive a "public option" given that private companies have to show a profit and government agencies do not have to – and given that a private enterprise must raise its own money to be solvent and a government option has access to others' money - i.e., taxes?

Answer:
Certainly. Private insurance continues to be available to those who want it in countries that have public insurance, and there will remain ample opportunity to provide the same kinds of coverage even with a public option in America. At the end of the day, however, the survival of the private health insurance industry is completely irrelevant to the issue of health care coverage, and is again a matter of economics within a given industry.


Question 7:
Why will hospitals, doctors, and pharmaceutical companies do nearly as superb a job as they now do if their reimbursement from the government will be severely cut? Haven't the laws of human behavior and common sense been repealed here in arguing that while doctors, hospitals and drug companies will make significantly less money they will continue to provide the same level of uniquely excellent care?

Answer:
The United States spends far more per capita on health care than any other industrialized nation. Yet for all of that expenditure, the U.S. is just 37th in the most recent World Health Organization (WHO) rankings of the world's health care systems, slightly ahead of Slovenia and Cuba, but behind such dynamos as Costa Rica, Dominica, Chile, Colombia, Morocco and Greece. Further, the United States ranks 47th in life expectancy at birth; 29th in infant mortality (down from 12th in 1960); and 14th out of 26 developed nations surveyed for deaths from heart disease. Americans also wait as long or longer for care as people in countries with national health insurance. It is unclear, therefore, how this performance is related to "uniquely excellent care," but it is likely that these standings are at least partially reflective of the effect tens of millions of Americans without insurance have on both cost and aggregate success.


Question 8:
Given how many needless procedures are ordered to avoid medical lawsuits and how much money doctors spend on medical malpractice insurance, shouldn't any meaningful "reform" of health care provide some remedy for frivolous malpractice lawsuits?

Answer:
Defensive medicine is not the sole reason for unneeded procedures; doctors and hospitals also order procedures for profit reasons, even in states with caps on medical malpractice awards. More important, however, is the fact that malpractice is only about 1 percent of health-care spending, even if defensive medicine is included. It is essentially a non-issue.


Question 9:
Given how weak the U.S. economy is, given how weak the U.S. dollar is, and given how much in debt the U.S. is in, why would anyone seek to have the U.S. spend another trillion dollars? Even if all the other questions here had legitimate answers, wouldn't the state of the U.S. economy alone argue against national health care at this time?

Answer:
Absolutely not. Not only are current inefficiencies in health insurance a serious drag on our economy that we would be well rid of, government spending to reform the system will act as significant economic stimulus. This is actually an excellent time for major changes, and viewed at a macroeconomic level from a long range perspective, health insurance reform is about cost shifting (private to public) and savings (elimination of overhead, reducing inefficiencies, broadening the pool of insured), not additional cost.


Question 10:
Contrary to the assertion of President Obama - "we spend much more on health care than any other nation but aren't any healthier for it" - we are healthier. We wait far less time for procedures and surgeries. Our life expectancy with virtually any major disease is longer. And if you do not count deaths from violent crime and automobile accidents, we also have the longest life expectancy. Do you think a government takeover of American medicine will enable this medical excellence to continue?

Answer:
Again, this question conflates health care and health care coverage, the first of which is not under discussion or debate. There is no plan in the bill for nationalizing health care (Anyone sensing a pattern here?), and the framing of this question - as illustrated amply by the statistics cited in the answer to Question 7 - is clearly and demonstrably untrue. We wait for care as long or longer than patients in countries with national insurance; no one excludes violent crime and automobile accidents from calculations of life expectancy; and while I was unable to find anything confirming or denying the assertion that "our life expectancy with virtually any major disease is longer," given the outright dishonesty in the other claims, I think we can charitably assume that it's a moot point, at best.

Far from being alien to our current debate on health care reform, the questions in Mr. Prager's column actually represent many of the arguments commonly used by those most loudly and stridently opposed to change. Understanding this, it is intensely illuminating to see the dishonesty and intellectual bankruptcy of these arguments, intended as they clearly are not to address the technical hurdles to productive reform, but instead to cloud the atmosphere with propaganda, fear-mongering and outright lies.

That being the case, it is clear that, for the right wing, this is a battle over ideology rather than an effort to solve a problem. Given that the stakes in solving the problem of health care reform are the lives and wellbeing of our fellow Americans, that is, frankly, despicable.

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Be sure to check out this clip from Robert Greenwald, entitled 450,000 Doctors Can't Be Wrong: