Patient Power

Incremental persuasion: Medicare and Medicaid

This post is about incremental persuasion and Medicare, and is intended for those who value each individual’s freedom to choose whether or not to give to charity, which charity to support, and persuading others to share the same value.  If this does not describe you, I beg of you not to read on, as it will render you immune the sneaky pro-liberty persuasion tactics described below.

…

OK, then.  Here goes…

There are degrees of individual freedom between how Medicare and Medicaid currently work and the free-market ideal of voluntary charities competing on a level playing field.  If you cannot persuade someone to your point of view, it’s not a lost cause.  Perhaps you can persuade that person to a view that is closer to yours.  That’s better than nothing, right?

Face it, the free-market ideal not a popular view.  But you can probably convince people that running Medicare/Medicaid like the food stamp program would be preferable to the current system.   That is, instead of a government acting as a insurance company, replace it with subsidies for private insurance.

Once you get that far, you could suggest charity tax-credits that would allow voluntary charities to compete fairly with government charities.  If the person you’re addressing is likes charity tax credits, then you can focus on whether politicians have any business telling you how much you should donate to charity in the first place.

Say you’re speaking to someone who thinks that

1. A proper role of government is to require that taxpayers pay for medical bills and/or insurance for the elderly and/or poor.   Taxpayers who peacefully refuse to do this face punishment.
2. Given (1) is true, therefore Medicare and Medicaid are justified.

But this reason (2) to support Medicaid and Medicare is a non sequitur .  It does not follow that if government should force taxpayers to subsidize medical care for the poor and elderly that Medicaid and Medicare are justified.

Similarly, if one thinks government should force taxpayers to buy food for those who cannot afford it, does not mean government should have a “Nutricare” program.  Here bureaucrats can determine how much they will pay grocery stores for a loaf of bread, and burden stores with loads of red tape and paperwork.   Instead, qualifying poor people receive money to buy food directly from retailers at market prices.

Last week’s Cato Institute podcast featured Michael Cannon.  He explains now such a system would be better than the current Medicare system:

Instead of having government tell seniors “here’s the package of benefits you’re gonna get, and here’s how much were gonna pay the doctors, and good luck finding a doctor if the reimbursement rates are too low.  Instead of doing all the and having the government micromanage everything from benefit decisions to pricing decisions, give the seniors the money government was going to spend on their behalf.

Give poor people a little more … give sick people a little more if that’s what they need to purchase a decent health insurance policy.  Decide how much you’re going to spend, divy it up among the seniors, and give it to them in a check.  Then let them decide what kind of benefits they want.   If they want an HMO that very tightly manages care, is very conservative about their treatment philosophy in order to weed out unnecessary services, then they can choose that kind of plan.  If they want a plan that provides very generous access to care, well then they can pay the high premiums associated with that plan.

The market forces that you’ll unleash there are going to solve these problems of how much we should be paying in order to get [a] given health outcome for a given senior.  They are also going to solve the problems of waste and unnecessary expenditures in a way that government is just not equipped to do.

Medicare is immoral for essentially two reasons.  First, it’s robbery because it empowers politicians to force taxpayers to donate money to a government run program.  Second, it also empowers politicians to dictate how doctors and patients interact.  If Medicare is run on the food stamps model that Cannon describes, yes, it’s still robbery, but in this case politicians will not be controlling the providers of the product nearly as much as they do now.

So if you cannot persuade someone that Medicare is immoral for both reasons, perhaps it’ll be more satisfying to get one of the two by suggesting the food-stamp model.

As a next incrimental step, you could suggest a charity tax-credit .  In the case of Medicare, say $500 of your taxes go to Medicare.  What if you could donate $500 to a Medical-care related charity of your choice, and pay $500 less in taxes such that Medicare would lose your “donation.”  Would you still donate it to Medicare?  Wouldn’t that be fair to voluntary charities, and also give Medicaid administrators incentives to earn your donation? 

If the person you’re addressing is likes charity tax credits, then you can focus on whether politicians have any business telling you how much you should donate to charity in the first place.

Many people will not interested in this final incremental step toward a more free, tolerant, and civil society, which people respect each-other’s right to live as they please.  Voters are often unwise and irrational.  You may not like it, it’s reality.  Given that, and if you can persuade someone part-way on health care, why not suggest the food-stamp model or charity tax credits for education.  That is, instead of government-run schools?  And then, how about a similar approach to replacing the entire welfare state?

• SB-160: Compulsory charity immoral & impractical
• Medicare pays squat, Pathways HomeCare Center closes
• Open letter to supporters of Colorado SB 160
• Colorado health care agency under investigation
• Medicaid strains ER more than uninsured