Health care debate

I went to hear Newt Gingrich and Howard Dean talk about health care last night. There was a good crowd — they had it set up in half of the Show Me Center, and it was packed to the point that they had to bring in a bunch of extra chairs to set up on the floor.

Gingrich is a much better speaker than Dean; Dean tends to stumble over his words, and his brain gets ahead of his mouth. Gingrich has good timing, and knows how to milk an applause line.

As far as substance, I thought Dean had a more realistic and nuanced understanding of the problem. Gingrich seems to think the whole issue can be solved via cracking down on waste, fraud, and abuse, investing more in medical research, and letting private corporations innovate.

Dean was honest about both the limited nature of what’s on the table right now — it’s at best a first step — and the fact that we have to pay for government programs. Gingrich got a lot of applause out of repeatedly talking about cutting taxes. He seems not to have learned much from the Reagan years, as he’s still claiming we can cut taxes, maintain services, and balance the budget.

Gingrich did say that the Republican party needs to be the party of alternatives rather than opposition, which is absolutely true; he acknowledged that the party is not offering any clear alternatives at the moment.

Dean made the point that health care is not like buying a car, in that when you have chest pain, you’re not going to shop around for treatment. We hear a lot about how good and cheap Lazik is because people pay for it out of pocket, but that only works for discretionary health procedures, where people actually have the time to comparison shop.

I agreed fully with Gingrich that medical research should be funded well, but I’m not sure how this figures into health care reform.  Most of the basic research in medicine in this country is funded by NIH, so we’re talking about increased spending there.  Admittedly, it’s an investment in better future health, which may save money in the long run, but you’re not going to get the private sector to fund basic research.

Their exchange on administrative costs is about what I’ve been reading in lots of other places lately.  Dean says that Medicare only has 4% admin costs, while private insurers have 20%; Gingrich says Medicare’s low admin cost comes at the price of 10% or more fraud.   Neither really addressed the problem that fraud figures are at best rough estimates.  If we knew the exact amount of fraud, we’d be stopping all of it.  Anecdotes about egregious crooks don’t actually tell you what the total cost is.

They also had the usual exchange about comparing European costs and outcomes to ours.  Dean says, correctly, that every other Western country spends less per person and has better health outcomes than we do.  Gingrich says, correctly, that we have the best care in the world and that we have better outcomes on certain conditions, especially some cancers.  The problem, of course, is that we have the best care in the world only for the handful who can pay for it, and while we have better outcomes on some conditions, our overall life expectancy puts us well behind all those European systems.

Finally, they talked a bit about some other issues.  On education, Gingrich touted charter schools and letting retirees teach about content they know.   Dean reminded him that knowing content doesn’t guarantee you can teach it well.  He also called for better education from birth to age three, when neurological development is really taking place.   He’s right on the mark there — as he says, Head Start is too late.

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