Friday, May 06, 2011

The Three Revelations of Eric Cantor. Or Conservative Principles on Health Care

Reading a particularly revealing piece like this one makes my knees go weak and my eyes light up with delirious joy. To be offered a well-known politician's real views for the tearing-apart process! I am not worthy.

The well-known politician in this case is Eric Cantor, the Republican House Majority Leader from Virginia, and the views he reveals to us are from a talk he gave to the College of American Pathologists, which is a fun detail, given what increases the customer base of pathologists.

Anyway, here is Cantor's First Revelation:
House Majority Leader Eric Cantor (R-Va.) said Tuesday that private healthcare plans ration care for profit but that consumers should be free to buy whatever coverage they can afford rather than depend on government rationing.
Free to buy whatever care they can afford! That is beautifully put. He is very clear on what his concerns are when it comes to the idea that governments might ration care: That might stop some people from buying loads and loads of care, even if they could afford it. The poor naturally are free to buy no care at all under the current system, if they can't afford it. So that is all right.

But those poor billionaires! In Cantor's world they are the true victims of government rationing. In the world the rest of us live all so-called socialized health care systems have auxiliary private insurance plans for those who wish them, which means that billionaires are not affected, except to the extent that they must still pay taxes to fund the public system. Perhaps it is this which Cantor finds so distasteful?

Cantor also thinks that the amount of care the not-so-rich can afford to buy on their own is the correct amount. Government plans are too generous:
In remarks to the College of American Pathologists, Cantor warned that Democrats' healthcare reform law mandates benefits that are too generous and will bankrupt the country as the government ends up having to offer ever increasing subsidies. That can only lead to government rationing, he said.
"That doesn't mean those kinds of decisions aren't being made now by the private sector," Cantor added, "because they are."
Indeed. Those kinds of decisions are made by the private sector, and the yardstick for rationing is money. If you can pay for a procedure you are likely to get it, whatever the nature of the procedure and whatever the seriousness or non-seriousness of your condition.

If you cannot pay for a procedure in the private market-place you will not get it, whatever the seriousness or non-seriousness of your condition. It is the government that you will turn to, then, but Cantor doesn't like that at all. I think he prefers a world where the dying lie outside the gates of the rich. It's Biblical.

And it matches the odd mixture of aggressive capitalism and right-wing Christianity which has so tainted the Republican Party. As the quoted article mentions, competition in health care markets does not bring prices down and does not guarantee quality, for reasons which have to do with the fundamental economic problems in that particular marketplace (uncertainty and severe informational asymmetry). But Cantor and others like him believe in the gods of free markets to such an extent that his Second Revelation is this:
Cantor appeared to go further than Republicans have in the past by acknowledging that not all patients are certain to get optimal healthcare under a system of private insurance. 
"I think that the fundamental nature of our system of third-party payer is the problem," he said. Patients, he added, too often are left with "no decision about what they want and what they can afford."
He does suggest that the care patients get under private insurance is not optimal. But note that what he thinks would be optimal is a system with no insurance at all! Because that way it is your wallet which hurts when all those bills come in, not the wallets of insurance companies and plans.

He's not talking about the problems of denial of services or of cherry-picking in the market, nope. He's referring to the ideal conservative jungle-world where you pay for all your health care expenses out-of-pocket. That way you will examine every proposed service, decide if it is worth the fee and then calmly and rationally either buy or refuse to buy the proposed package. All this from your hospital bed or nursing-home wheelchair!

I must be fair here and acknowledge that Cantor probably isn't planning to ban health insurance. But what he refers to in the above quote is a traditional conservative economic argument: If only people had to directly pay for their own health care consumption they would be more careful about how much to spend!

And they would be. In the case of catastrophic illnesses they would have to choose between losing everything and getting the recommended treatment, even if that treatment bankrupts not only the patient but her or his whole family. Health care costs, by the way, are a common reason for bankruptcies in this country, even with health insurance. The situation without it would be devastating. But sure, people would mind their money like hawks. Or try to.

To recap, Cantor wants rationing to take place not by the government and not ultimately by the marketplace, either. It is the individual patient who is supposed to simply accept the fact that he or she can't afford medical care and choose the alternative. That way the rest of us don't have to pay taxes for the treatment of Others. It is invisible rationing until the dying arrive at the gates of the rich.

But Cantor is not so heartless as these quotes might have made him look, no. Because he gives us his Third Revelation:
Later, Cantor said Republicans want a safety net for people who can't afford care but that "we're not for everyone having the same outcome guaranteed."
They are not for everyone having the same outcome guaranteed. The safety net care should take place in industrial bunkers, with gray walls, bad cabbage-soup as the meal of the day, fewer medications, fewer health care professionals and cheaper care in general. Possibly even death panels?

I'm joking there. But the usual conservative description goes something like my previous paragraph. It never occurred to me that Cantor and others like him hold it as the proper way government-funded care should be: Second rate, intended for those who don't have enough money.

Note that suddenly Cantor IS all for government rationing, too. It's just that the rationing should only apply to the poor, not to Cantor. In his world the markets should ration care, those who can't afford it are quite free not to have any, but because we are charitable people they can get tax-funded care which will be rationed in quality if not in quantity.