Arnold Schwarzenegger joins Mitt Romney as a prominent Republican proposing a government health care plan to provide universal coverage. Needless to say, this has created considerable controversy among conservatives. PrestoPundit compares the health care positions of Schwarzenegger to Milton Friedman, and many other conservative bloggers also feel betrayed that someone who sounded like one of them is proposing such a major government program rather than relying on the free market to solve the problem.
There is a major difference between people like Schwarzenegger and Romney compared to conservative writers and bloggers. Governors have to actually solve problems, and cannot hide behind ideology when it fails. While the free market out performs government in most activities, health care is one area where the market has failed. The current system is collapsing and people like Schwarzenegger see no choice but to use the government to attempt to fix the problem.
I am speaking in general here about the need for govenment action without necessarily endorsing all the specifics of Schwarzenegger’s plan. There certainly are also down sides. While they might be right on some objections to the plan, I’m seeing many of the common claims made by people outside of health care which should be dispensed with so that the plan could be considered on its true merits and faults.
Captain’s Quarters raises the usual scares of a government take over, writing “While not a single-payor system on the surface, the new regulation would dictate the terms for insurers in such a way that government will effectively take over most of the decision-making for medical coverage and payouts.” While the scares about “socialized medicine” remain common in the conservative media, I hear far less of this from colleagues now than ten to twenty years ago. While different individual’s experiences may vary, in general restrictions from business have been far more onerous than those from Medicare. I have a number of patients who I would prefer to be in Medicare than the plans they currently have, making “socialized medicine” appear far less threatening.
Schwarzenegger proposes a two percent tax on physicians. A Stich in Haste calls this a “war on physicians.” Captain’s Quarters predicts, “Health care providers will decline, since taxes provide a disincentive to the market; doctors will find other venues in which to practice, and the best will capture the most lucrative economic positions, none of which will now be in California.” The Autopsy takes this further in fearing that “because everyone has health coverage, more people will go to the doctor, and there will be less doctors to see the patients. As a result, appointments will have to be made months in advance and urgent-care visits will be done through emergency room care just to guarantee a speedy appointment.”
The two percent tax will certainly be controversial, but it is far from clear that it will result in less doctors practicing. As The Autopsy even admits, this will increase demand for physician services. In addition to allowing for increased income, having a fully insured population would eliminate the major source of bad debts and even allow me slash my marketing expenses. I suspect that these financial benefits would increase my profits by well over two percent, eliminating any incentive to leave the state if such a plan were proposed here. To further improve the benefits for physicians, and as well as improving access for patients, Schwarzenegger also proposes an increase in payment from California’s version of Medicaid. Without knowing the specifics I cannot say if this will be adequate, but with all the politicians utilizing expansion of Medicaid in various plans I am impressed to see that Schwarzenegger is at least addressing the problem of inadequate reimbursement from Medicaid. (more…)
