The problem with being an economist, a newspaper columnist, or both, is that you might get a distorted view of the real world from looking at abstract data. Paul Krugman once again demonstrates this in today’s column. He has attacked Obama’s health plan with such regularity that we knew it was time for another attack. Daniel Drezner, writing at Megan McArdle’s blog, has predicting Krugman down to a science. His formula ends with Krugman’s columns arguing “Barack Obama is not a real progressive.”
If you are one of those people who believes that everything which is accepted as truth in the liberal blogosphere is true, and anything proposed by a Republican such as John McCain is not only wrong but evil, you might as well stop here because you are not going to agree with this post. Today John McCain is right and many liberal bloggers, along with Paul Krugman, are wrong.
While there is plenty to criticize in John McCain’s health care plan, Krugman chose to attack an aspect which is actually a good idea (and which is similar to a proposal made by Democrat Bill Richardson). Krugman quotes from McCain’s web site:
“America’s veterans have fought for our freedom,” says the McCain Web site. “We should give them freedom to choose to carry their V.A. dollars to a provider that gives them the timely care at high quality and in the best location.”
Krugman fails to recognize that this is a good idea as he has been suckered into the belief, repeated by many liberal bloggers, that the V.A. health system is the Mecca of health care. This fallacy comes from computerized reports which evaluate health care plans. The problem, as most people who actually work in health care realize, is that the state of the art of evaluating medical outcomes is still quite primitive. Krugman raves about the integrated system and their use of information technology. While this probably has brought about significant improvements, the main benefit of such a system is the ability to generate data which improves their ratings.
In the private sector, there is very poor data available to evaluate care provided. Some H.M.O’s are trying, but their data at this point is pathetic. Private practices providing good care will not be recognized. The V.A. has an advantage as their system can provide just what data is needed to make themselves look good.
Those of us who actually see patients who also go to the V.A. system, as opposed to relying on computerized print outs, see plenty of evidence that the V.A. system has its faults. I see many patients who come to me because they do not receive adequate care from the V.A. They often go the the V.A. intermittently because they pay for their medications but do not receive meaningful care to manage their medical problems. The decisions made by the V.A. with regards to medications are frequently based upon short term cost.
Sometimes it is not only beneficial to the patient but also more cost effective in the long run to pay more to treat chronic diseases aggressively at an earlier stage. For example, while the consensus is that lowering the LDL to under 70 is beneficial in regressing heart disease in many patients, I’ve had the V.A. refuse to cover additional medications once the LDL is below 110. It wouldn’t take very many extra bypass surgeries to blow all the savings from refusing medications.
Hopefully some readers are thinking, “to hell with the cost benefits. If the medications mean I’m less likly to need bypass surgery, or less likely to die of a heart attack, I want to go with the current medical recommendations, not V.A. policy.” This comes down to that C-Word which Paul Krugman hates: Choice. Patients might want the choice to receive the medications recommended for their problems, not those which the V.A. finds most cost effective.
I fail to understand why some liberals defend choice when it comes to abortion rights, as they should, but some have absolutely no respect for an individual’s choice in matters such as health care and personal economic decisions. The V.A. system does vary in quality. There are also geographical issues. People often have to drive a long distance to receive care from the V.A. if going to the closest provider, and I also know of people who drive further to get to a V.A. facility they believe is of a higher quality than the closest.
John McCain is right. Let the veterans go where they choose. If the V.A. system is really the Mecca that many liberals believe it is, they will have no problem maintaining keeping patients coming. Paul Krugman believes that the V.A. system will collapse if patients have a choice to go elsewhere. Isn’t this a confession that the V.A. isn’t really providing the best care available?
John McCain is right on this one, but this is an easy issue. Changing health care for those who already have coverage is the easy part. The hard part is helping those who cannot afford health care coverage and who want to receive coverage. That’s where Barack Obama has an advantage over John McCain since McCain’s plans will do very little to help these people. Krugman once again objects because Obama’s plan includes choice. Those who both need and want his plan can take advantage of it, but everyone has a choice. Krugman writes:
Worse yet, Mr. Obama attacked his Democratic rivals’ health plans using conservative talking points about choice and the evil of having the government tell you what to do. That’s going to make it hard — if he is the nominee — to refute Mr. McCain when he makes similar arguments on behalf of such things as privatizing veterans’ care.
In other words, by supporting choice Obama gives cover to John McCain in a case where he is right. Partisan Democrats (many of whom probably should have stopped with my second paragraph) might see some logic to this if their primary goal is for Republicans to always be wrong. For those of us who want to solve problems regardless of partisanship, there’s no problem here. If it makes liberal blog readers feel better, remember that this isn’t only a Republican proposal. Bill Richardson proposed the same thing.
Paul Krugman gives conservatives quite a bit of help by spreading the fallacy that conservatives support choice and liberals support “having the government tell you what to do.” If these were the real differences between liberals and conservatives, I’d rather be a conservative, and so would the majority of Americans. Conservatives, who are hardly the supporters of choice and personal freedom which Krugman would portray them as, have benefited in many elections by portraying themselves in this manner, with the help of some such as Paul Krugman.
The reality is that Republicans talk about choice, but they seldom deliver on their rhetoric. They have no qualms about pushing the agenda of the religious right to pick up a few more votes(even though many Republicans don’t think much of their allies). Liberalism is at a cross roads after having been out of power. Some, such as Krugman and Clinton, are reactionary supporters of failed big government liberalism. Others of us stress civil liberties and favor individual choice as much as possible. We don’t know for certain what Barack Obama will do in office but, in contrast to Clinton, he has shown signs of understanding the limitations of a top-down government approach. His health care plan is just one example of this.