It’s been a while since I’ve taken a look at my conservative blogging counterpart’s Bashing Blumner series: he’s only done a few posts on her, because PolitiFact has been keeping him pretty busy. This recent post takes the St. Petersburg Times columnist to task for her seemingly poor reasoning with regard to the high costs of health care. And he may be right: but she has a very good point too.
In a column dated March 4, Robyn Blumner derided the Republicans' favorite method of reducing the high cost of health care, to wit, “tort reform is the magic bullet to cost containment…” Bryan White responds to that with “Blumner apparently thought it unnecessary to provide any example of the type of advocacy with which she charges Republicans.”
So, I’ll do Blumner a favor: straight from GOP.gov are here described the first three “steps” of their “approach to health care reform” in a PDF document entitled “The Reform America can Afford Act (H.R. 5424)”:
1. Lowering health care premiums 20% with no other explanation -- so I guess through all these steps, lowering premiums would be the “result” of their "magic bullet" reform.
2. Reforming high risk pools – to make insurance available to those with pre-existing conditions, which if anything would increase costs because those who would be making claims and therefore would cost the insurers more would now by theory be able to get insurance, so this is more of a give-away……
3. Ending “junk lawsuits” through “enacting medical liability reforms”--- which is another way of saying TORT REFORM….
So, PolitiFact might give Blumner a Mostly True or Half True on that one, but it’s still true that tort reform is quite high—let’s say Number Two--on the Republican List of health care reforms.
The heart of Blumner’s article, however, is this, which Bryan terms “magical thinking”:
Bryan really latches onto the two words “bad jobs” as his “magic” ammunition:While defensive medicine — where doctors order tests and procedures as a hedge against malpractice suits — undoubtedly adds unnecessary costs, it is not the main driver. That dishonor goes to one overarching factor: bad jobs — something Republicans don't want to talk about.
Blumner's claim is sheer lunacy, unless by "bad jobs" she literally means jobs that result in making it more likely that workers will require expensive medical care. The only thing a bad job does is make health care, at whatever price it carries, less affordable.
He goes on to deftly describe what he believes is the “primary driver of increased medical costs: medical innovation.” And he’s correct in a certain respect:
Occasionally, scholarly studies emerge that try to explain the explosion of health care costs by identifying the various component parts of the health care system-e.g., technology, prescription drugs, hospitals, physicians, and administrative costs-in order to assess (or blame) which component is ultimately driving the increase and by how much. For example, the bipartisan Congressional Budget Office (CBO), the federal agency that estimates the fiscal impact of proposed legislation, recently published a study estimating that "about half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in technology.
On the other hand, let’s take a good look at what Blumner really means by “bad jobs.”
First off, as of late, bad jobs, or NO jobs may be driving up healthcare costs. At first, I thought that’s what Blumner meant: (emphasis added)
Costs will rise in part because workers worried about losing their jobs are using their health care more while they still have it, the firm said in the report released to the Associated Press. The report also said rising unemployment is driving up medical costs.
However, on reviewing Blumner’s context supporting “bad jobs”, one can see the path she’s taking:
Rueben says he saw it firsthand. When he lived in Minnesota, employers there such as 3M, IBM and General Mills provided comprehensive health insurance to employees, giving Minnesotans access to primary care and keeping the population healthier. In Florida, businesses are less likely to provide health coverage to their workers or pay them a wage that lets them see a doctor easily. In general, Floridians don't enter the medical system until their conditions have become more advanced and more expensive to treat
There's a correlation between having health insurance and being healthy," Rueben says.
The “important distinction progressives like Blumner seem to handle with difficulty” leads us an important distinction conservatives like Bryan seem to handle with difficulty as well: Bryan only considered the SUPPLY side (the health care system), while it’s very clear Blumner is talking about the DEMAND side (those who use the health care system), as cost drivers.
This is akin to the “supply side” economics of Republicans versus “consumption” or “demand” economics which progressives embrace.
The best illustration of this is by comparing the “ten healthiest states in America” with the “ten least healthy states in America” as a very interesting pattern emerges, with very few exceptions, as seen in this spreadsheet.
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| There may be some disagreement on specific red versus blue states, but the trends are clear. |
Of the ten healthiest states in America, Hawaii was Number Two and Massachusetts was Number Six. Hawaii has had a "government takeover" of health care for forty years, and we all know about Massachusetts. It seems the liberal bastion of New England scored five states of the top ten. Then look at the ten least healthy states in America. While Florida has gone pretty “red” in voting in Republicans this last election, even if we call it a blue state for “charitable” purposes, the least healthy state list is 80% red states; while the most healthy state list is 80% blue states.
Aside from Hawaii and Massachusetts, if you just look at the percent of those who have insurance by state, the “healthy” states have more insured than the least healthy states. Texas has the honor of being the state with the most uninsured in the country; but the least healthy states averaged 17% to 22% of their citizenry without insurance. The “most healthy states” averaged 8% to 12%.
Not only that, eight of the “fattest” states were on the “least healthy list” as well (and they were all the red states), and on average had close to 40% more people who have been told they were diabetic (10.1% diabetic on average for the least healthy states versus 7.25% for the most healthy states).
Just for the heck of it, I also decided to include the numbers for federal tax outlays to revenues (O/R) as reported by taxfoundation.org: while there were some divergences (Florida, Texas and Hawaii), the least healthy states get more federal tax revenue than they pay in taxes by an average factor of 1.28, while the healthy states were putting in exactly what they were taking out (average 1.0).
To be fair, the “most healthy” states also spent more per person for health care, I don’t know if the numbers are adjusted for those uninsured, but based on the latest numbers I could obtain from 2004, it was about 12% more per person in the blue states. If it was not adjusted, the greater percentage of people without insurance would certainly explain the lower amount per person in the “least healthy” states.
So Blumner makes a very strong argument on “bad jobs”: because who are the consumers of health care? Unless you’re just getting an annual physical, most of the demand is from those who are sick. And what is driving a lot of “sickness” lately, and what is its cost?
What is the cost of obesity?
...On average, people who are considered obese pay $1,429 (42 percent) more in health care costs than normal-weight individuals.
So while innovation may be driving costs up on the supply side of the health care industry, not being able to afford health care (because of a "bad job") and its correlating poor health (as demonstrated here by the increased obesity and diabetes in poor health states) are driving it up as well on the demand side. It should be noted that all the least healthy states are also right to work states, also known as “right to work for less” because “in 2009, workers in right-to-work states made $2.67 per hour less than workers in non-right-to-work states. That adds up to $5,553.60 less a year.” In other words, while conservatives might say there have been more jobs added in right to work states, they are more likely to be “bad jobs.”
Maybe Blumner could have said it better. But “bad jobs” isn’t lunacy by any stretch, as some would have you believe.
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