Thoughts, essays, and writings on Liberty. Written by the heirs of Patrick Henry.

September 3, 2007

John Edwards: You’ll Go To The Doctor Whether You Want To Or Not

by Doug Mataconis

John Edwards was in Iowa yesterday and demonstrated in a few short words what’s wrong with most of the Democratic Party:

Democratic presidential hopeful John Edwards said on Sunday that his universal health care proposal would require that Americans go to the doctor for preventive care.

“It requires that everybody be covered. It requires that everybody get preventive care,” he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. “If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”

He noted, for example, that women would be required to have regular mammograms in an effort to find and treat “the first trace of problem.” Edwards and his wife, Elizabeth, announced earlier this year that her breast cancer had returned and spread.

Edwards said his mandatory health care plan would cover preventive, chronic and long-term health care. The plan would include mental health care as well as dental and vision coverage for all Americans.

“The whole idea is a continuum of care, basically from birth to death,” he said.

The former North Carolina senator said all presidential candidates talking about health care “ought to be asked one question: Does your plan cover every single American?”

“Because if it doesn’t they should be made to explain what child, what woman, what man in America is not worthy of health care,” he said. “Because in my view, everybody is worth health care.”

Edwards said his plan would cost up to $120 billion a year, a cost he proposes covering by ending President Bush’s tax cuts to people who make more than $200,000 per year.

If you accept the logic of government provided universal health care coverage, then Edwards’ proposal actually makes sense. After all, if the taxpayers are paying for your health care, we can’t let you do anything unhealthy now can we ? We’ll ban smoking in practically every public venue, take trans-fats off the market, require food makers to slap labels on their product that are more confusing than anything else and, then, we’ll tell you that you don’t have the right to decide to seek medical care or not.

Is it wise to go to a doctor on a regular basis and get a check up ? Generally, yes.

Is it the place of the government to force you to do it ? In John Edwards’ America, where pro-choice apparently only applies to some medical procedures, the answer is apparently yes.

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  • http://www.lunchworks.net Jeff Molby

    We’ll ban smoking in practically every public venue

    “public venue”?? Thanks for the laugh, Doug. Under a program like this, they’d finally have the justification to ban it completely.

  • UCrawford

    Yup…the totalitarian implications of public health. Reason did an article by that title a couple of months ago.

  • Bob

    The real scarey thing is the number of Americans who support Edwards and the number who won’t see a problem with this. I road tested this idea this morning. Most people didn’t see a problem with this unitl I really harped on the manditory aspect and even then a sizeable number didn’t have a problem with it.

  • Chepe Noyon

    As the author points out, it is logical to mandate preventative health checkups when you’re paying the costs of health care. The issue is not whether such mandates should be part of a health care program, but whether there should be a health care program and whether people should be required to participate. The situation right now is grossly distorted by market inefficiencies. Big insurers are able to squeeze medical care providers to deliver services at just above cost, so that the individual consumer of health care services has to pay a premium. If the market were functioning efficiently, then I think that we wouldn’t need government-provided health care.

    Compounding this are two additional problems:

    1. The typical health care consumer doesn’t have the time to properly evaluate medical options. My doctor is pushing a very ambitious megavitamin program on me, and I’m skeptical, but I don’t have the time to research the issue. The end result is that most consumers take pennywise pound-foolish strategies.

    2. Our legal system imposes enormous financial burdens on the health care system in terms of keeping people alive when their prognosis is poor. On average, we spend more money on the last year of life than on the entire previous life of the patient. This is absurd. We need an economically rational way of evaluating health care costs and benefits, and that will require us to admit to ourselves that keeping some patients alive is just not worth the cost.

    My preferred approach is something like the health care account concept. Get rid of all forms of health care insurance and let the government deposit a hunk of money into a citizen’s health care account at birth. It should be enough money to take care of the average person through, say, age twenty-five. The citizen must start contributing to his own health care in adulthood, but the government provides some tax incentives to keep the citizen out of the emergency room. There would remain all sorts of details to work out (does the government provide fast loans to people whose accounts are drained by a serious illness but who should be able to return to a productive life later? Or should this be left to the market?)

  • Bob

    Still too much government involvement for my taste. Allow me to worry about my own health care, thank you. The constitution doesn’t say anything about government taxing me so they can provide health care for everyone under 25. Also, what if at age 26 I don’t want to take care/contribute to my health care? Leave it to the market over the long run it’ll be a lot cheaper and easier.

  • Chepe Noyon

    You’re quite right that this is still an intrusive approach — but it would mean the government taking fewer tax dollars away from you and giving them to somebody else. It’s fundamentally a cost-saving measure, and so ultimately adds up to less overall government intrusiveness.

  • http://www.bigdavesplace.com Dave Neuman

    John Edwards can Kiss my ass. I do what I want – 24/7/365.

  • Quincy

    Chepe Noyon –

    The market inefficiencies of which you speak are actually market distortions introduced by the tax code. Have you ever wondered *why* insurers can get away with providing the cheapest, cruddiest service possible without facing a market penalty? It’s really, really simple: insurers (by and large) work for employers, not consumers. The incentive structure works roughly like this:

    1. A loophole exists in the tax code making health care dollars spent by employer’s tax free, while health care dollars spent by consumers are taxed.

    2. Employers see this loophole as a way to get more bang for their compensatory buck, as it were.

    3. They shop around for health insurance for their employees, looking mainly or solely at cost.

    4. Insurance companies all strive to market a competitive product on the basis of cost, making trade-offs everywhere else, including quality of care and customer experience.

    Nowhere in the above does the consumer have a direct influence on the insurer. This makes it impossible for the market to function efficiently, since market efficiencies are gained when consumer and producer are both enabled to make decisions in their own best interest while exerting leverage on one another. Here, the producers have the leverage, but the consumers do not.

    In addition, one must consider that the one “insurer” (I deign to even call it that) that is exerting truly undue pressure on health care prices and forcing health care providers to redistribute the costs is *Medicare/Medicaid*. Knowing several people who’ve worked in health care administration, the constant complaint I hear is that the federal health programs are the ones consistently underpaying, not private insurers. (An anecdote ain’t evidence, I know, but I suspect it’s the same all over the country.)

    You say:

    If the market were functioning efficiently, then I think that we wouldn’t need government-provided health care.

    I say, the federal government is preventing the market from functioning efficiently therefore creating a “need” for the very same federal government to step in with the offer of a “better way”. Insidious, isn’t it?

  • UCrawford

    Quincy,

    Well put.

  • Eric

    Not only well put, but completely true. It goes further, of course. The payors and hospital providers exert tremendous influence on Congress and the Administration not to change things. Why? Because giving the consumer a say would bring down the house of cards they’ve built.

  • Chepe Noyon

    Yes, the tax code is the original market distorter here and we really should eliminate that stupid tax break. With it out of the way, there will still be problems arising from big insurers being able to distort the market, but I agree that they are secondary. And I further agree that Medicare is yet another huge market distortion.

    None of this, however, reduces the interest that every citizen has in the health of children. It has nothing to do with altruism; it’s a matter of setting up a good taxpayer base for one’s old age.

  • Eric

    I am also interested in making sure that my children are educated, have a job, raise a family, behave in an ethical fashion, etc. I don’t see any of those things as being any more, or less, crucial than their health.

    And, of course, I don’t see any reason to depend upon the government to provide those things. In fact, so far as I can tell, if I left it to the government and the central planners, none of those things would be accomplished for my children. Or your children either.

  • Quincy

    None of this, however, reduces the interest that every citizen has in the health of children.

    That’s changing the subject just a bit, isn’t it? Neither Edwards, nor you, nor I, nor anyone else, was talking about children. Providing for children, who are not full actors in our society, is an entirely different debate. (Though I tent towards Eric’s view of *still* not trusting the government or other central authority to do it. Look at what they’ve done with education.)

    The fact of the matter is that Edwards is talking about imposing centralized health care on everyone, not just children. He seeks to replace a system where the consumer is ignored in favor of the employer, who at least is somewhat influenced by consumers (who can always seek another job), to the government, which has police power over those same consumers. In terms of responsiveness, does this at all seem like a good idea?

  • Chepe Noyon

    Quincy, I agree that universal health care is a different topic than health care for children — but I hope you will agree that it is in our best interests to insure that children of poor parents get all the basic health care they need.

    Eric, perhaps you misunderstood my point. I’m arguing that my overall tax burden is reduced if there are other citizens — healthy, well-educated citizens earning lots of money — to share the tax burden with me. Therefore, an investment of $X today might yield $X+$dx tomorrow. Now, I don’t know what the value of dx is, but what little I have seen in the way of data here suggests that we would do well to spend plenty of money here.

  • Quincy

    Chepe Noyon –

    I must say, I admire your honesty when you say, “It has nothing to do with altruism; it’s a matter of setting up a good taxpayer base for one’s old age.”

    While the honesty is admirable, the sentiment is anything but. It saddens me that entire generations that have grown up on the Ponzi scheme that is Social Security view my future earnings, and the future earnings of every American younger than they are, as some sort of entitlement. Quite frankly, as an American under thirty, I’m not only saddened but a little disgusted at the way my elders view my generation as a mere tax base to be exploited in their old age.

    Now back to the original discussion, universal health care, I do see where you steered the discussion towards health care for the young, and your idea of a health spending account for minors is an interesting one. Personally, I’d much rather reformulate the tax code to eliminate the perverse incentives above, first, as I believe the number of uninsured children would drop precipitously when parents could find one health plan that’s a good fit for their family and not have to keep changing every time they lose/change a job. [This is yet another flaw with the tax loophole. As workers tend to work more jobs over their careers, they tend to have more coverage gaps (COBRA, etc., notwithstanding).]

    In short, trying to implement more programs on top of a fundamentally flawed base is a recipe for disaster. We, as a nation, need to face the fact that the incentive structure of our health care system is broken, and can only be fixed by removing the government interference that has broken it.

  • Chepe Noyon

    Quincy, I erred in mentioning my old age; my argument is in no wise dependent upon income transfer from young to old. The only connection here is that the benefits I reap from such policies are not immediate, but are instead deferred by several decades. They’re still benefits, and the investment can still yield positive net returns.

    I agree that this is not the topic to discuss Social Security — but I look forward to that discussion; I’m sure it will come up.

    Again, I’m in agreement that we need to alter the tax code to fix its distorting effects. We should not forget that the elimination of the insurance provision will provide tax receipts that could be applied to the health care accounts system — if we’re lucky, the whole thing might even be tax neutral.

  • kitty

    “If you accept the logic of government provided universal health care coverage, then Edwards’ proposal actually makes sense.”
    Actually it doesn’t. Contrary to popular belief most of preventive care (I am talking about prevention of chronic conditions) is not cost-saving. It is actually quite expensive if you consider how many people need to be tested, treated for how many years for one bad thing to be prevented. This concept – number of people that need to be treated (screened) is often gets lost. One thinks “it is cheaper to give people statins than to treat a heart attack” but one forgets how many people need to be treated for many years in order to prevent this one heart attack (that may actually be fatal).

    Every time you go to a doctor, the doctor orders tests, sometimes necessary tests, sometimes not so necessary tests. Tests have false positives that need to be evaluated, tests may result in overdiagnosis of some conditions, so more people need to be treated. You may get prescribed preventive drugs. While this may prevent bad things in some a (very small) percentage of the population, you need to treat/screen hundreds, in some cases thousands of people to prevent one heart attack or catch one case of cancer early. There’s been a number of studies (pick a measure of your choice and google for “cost-saving”) that showed that while these measures do save lives, and may provide good value (cost-effectiveness) in terms of the cost of one quality-adjusted life year, they are NOT at all cost-savings, not even in high risk individuals and certainly not in low risk people.
    I am not arguing against preventive care, only that a person who chooses to not participate may miss his/her chance of preventing something bad, this person is not affecting anybody else adversely. In fact this person is more likely to save money.

  • Chepe Noyon

    kitty, your point is well-made, but you leave a question unanswered: how confined are preventative regimes that don’t save money? I can certainly understand how prevention of heart attacks by mass use of an expensive drug is not cost-effective. But there are surely lots of preventative regimes that ARE cost-effective. I’ll mention one that might or might not be cost-effective: saw palmetto as a preventative to prostate cancer. I don’t know what reduction in incidence of prostate cancer the treatment offers, but I do know that a lifetime’s supply of saw palmetto would cost about a thousand dollars.

    How about one aspirin per day to reduce heart disease? Is that cost-effective?

  • Quincy

    Chepe –

    Actually, closing the tax loophole without lowering individual income tax rates would be a tax increase on the population, so it would almost certainly produce revenue for (yet another) healthcare program from Uncle Sam. However, I’d much rather be methodical about how we’re handling the situation. Remove the distorting government policies and programs first, wait for the market to readjust and stabilize, then begin to consider additional steps. If you start putting other measures in place at the same time you remove the distortion, you may very well be introducing a new distortion without realizing it.

  • Chepe Noyon

    Good point, Quincy.

  • trumpetbob15

    Umm…I just have one question for John Edwards. With all his millions upon millions of dollars, how come his wife’s preventative health care didn’t detect her cancer and prevent it the first time through? If his money couldn’t find it, why should a poorer government program be even more successful? I guess I am too much of a simpleton for Edwards because I ask the bare bones question he conveniently forgets.

  • bhamMD

    As an internist, someone who would be “forced” to see all of these patients under Mr. Edwards’ plan, I question whether he has thought about the fact that there is a primary care shortage in this country, and the fact that Medicare continues to decrease reimbursements to internists and family practioners. Over the past several years, I have watched interest in general internal medicine by graduating residents from good training programs drop precipitously, simply because the government has set a compensation scheme that favors specialists (dermatologists, radiologists, anesthesiologists, medicine subspecialties such as gastroenterology and cardiology) over the primary care physician.

    All Mr. Edwards’ plan is going to do is make my job of providing the best care that I can to my patients much harder. As it is now, I can work in a number of patients every day while still providing quality time and care to my patients and having some semblance of a life. Who is going to want to practice Internal Medicine, Family Medicine, or Pediatrics if a system like this is shoved down our throats? Which patient is going to want to see their PCP if they’re to busy to see them because they’re busy doing mandatory physicals? I predict that ER visits (the most expensive venue for health care) would increase under this plan markedly. Who’s going to pay for that?

    Create a free-market system where the price of medical care in this country (specifically services provided by subspecialists) can come down. Make it easier for those of us who enjoy practicing medicine to practice medicine by getting rid of ridiculously complicated payment schemes (i.e., Medicare, which all of the insurance plans subsequently base their rates on). Penalize physicians who order unnecessary tests for their own benefit (yearly cardiac stress tests, every 2 year colonoscopies), and perhaps you’ll see the number of General Internal Medicine, Pediatrics, and Family Medicine practitioners rise. Maybe then you’ll have enough physicians to make your plan work, Mr. Edwards. Then your challenge will be to actually make people give a damn about their health…

  • Chepe Noyon

    trumpetbob15, that’s a cheap shot. Preventative care doesn’t prevent ALL disease — it only prevents SOME diseases from progressing to a dangerous point. In Mrs. Edwards’ case, preventative care was not enough. That doesn’t mean that some forms of preventative care are not cost-effective.

  • Chris Kachouroff

    Dr. Bham,

    You need not worry about Edwards’ plan. It’s not going to happen.

    In order to drive health care costs down, would you require the AMA to release its hold on the number of doctors that can be created every year? As I understand it, the AMA creates a number based on what it perceives is needed by the market or can be handled by the market. The law profession does not have such limits.

  • trumpetbob15

    Chepe,

    No, that wasn’t a cheap shot. Just a simple observation. You use the word cost-effective, but to who? If Elizabeth Edwards got preventative care or not does not concern me currently. John Edwards would like to change that. He wants to force me to go to the doctor’s office when I don’t need to and to force me to pay for everybody else to go as well. Why shouldn’t I be able to question the science behind his claim? If preventative care is not foolproof, then we need a cost/benefit analysis, not a wonder program from the government.

    However, you do make a great point. Preventative care can help prevent diseases from getting worse. Unfortunately for many in the Democrat Party, their plans seem to be emphasizing curing all diseases. Edwards’s plan is simply the same old tune with different words. Until he understands the point you made, that not all diseases can be prevented, his plan has a fatal flaw, even if you do consider it a cheap shot. Ignoring criticism of his own family’s health with all their money does not invalidate my point about his program.

  • Chepe Noyon

    trumpetbob15, I think I see the basis of our disagreement; it lies in this statement of yours:

    “Unfortunately for many in the Democrat Party, their plans seem to be emphasizing curing all diseases.”

    That’s not what I read in the various health plan schemes I have seen. Could you provide some evidence in support of this patently preposterous claim?

  • trumpetbob15

    Chepe,

    That is my impression. The schemes I have seen all seem to believe that diseases can be cured (“If only we do fetus stem cell research, Christopher Reeve will walk again,” or something along those lines by Edwards during the 2004 campaign). Look at the this quote from the article:

    He noted, for example, that women would be required to have regular mammograms in an effort to find and treat “the first trace of problem.”

    That assumes that preventative care would find “the first trace of the problem,” but as you mentioned above, preventative care does not always work.

    I take a different view. I believe diseases are always going to exist (just like poverty) and that while an expensive preventative test could detect a disease early, actually paying for the disease later may not be as expensive as the test itself given to everybody. However, I will rephrase my quote because it was poorly written. Democrats talk about curing all diseases and emphasize how this or that government program will help everybody, but the system they want to put in place would only cure diseases for the rich while making the poor wait in line for the preventative testing itself. (The plans I have seen, both HillaryCare and the ideas presented by Edwards, utilize universal health care along the same lines as Canadian and British, both of which have previously been discussed on this blog.) I hope this helps better explain my perceptions of the Democrat plans.

  • Chepe Noyon

    I don’t think you’re being precise in your analysis of the language. Here’s the crucial section of your quote:

    “in an effort to find and treat “the first trace of problem.””

    Note that word “effort”. It means that the desire is to find and treat the first trace of the problem — but that the possibility of failure is recognized. Notice also that the consequent verbs are ‘find and treat’, not ‘cure’.

    I’m surprised by your assertion that the Democratic schemes would help only the rich. Could you elaborate on that?

  • trumpetbob15

    Sure, I can elaborate. If someone has money or power, doctors can be found in socialized medicine countries. Everybody else stands in line, possibly getting to the point where treatment isn’t possible. Now, it is possible for Edwards’s program to try and get everybody into the doctor’s office – that is his stated goal – but the average person can’t afford to go more often. This leads to the universal health care. Unfortunately, money doesn’t grow on trees and universal health care is expensive. Someone has to get the shaft and looking to the countries idolized by Clinton and Edwards, the middle class gets hurt. The rich will always be able to leave the country (as they do now in Canada, coming here for hip replacement and cancer treatments), but everybody else has to suffer through the system. Preventative care will require more time and money on the front-end, legal mechanisms to force people to go to the doctor’s office, and the tests could all come back negative. Even if all the tests are successfully negative, what is the cost for administering an unneeded test simply because without the test, the government may not pay for treatment later on if symptoms develop?

    Perhaps I am too cynical, but I would rather just leave Edwards to deal with his own health and me to look after mine rather than trying to make us both accountable for each other. Health care won’t be solved by government, just like poverty wasn’t solved by a government War on Poverty. People will be sick and people will do stupid things. The best strategy is just to force people to mitigate risks themselves and to pay for any mistakes they make directly, rather than having everybody else subsidize their stupidity. My initial remark about Elizabeth Edwards’s cancer was to emphasize that more money won’t automatically mean better preventative care or even actual care. While her wealth will get her the best care possible, it might not be enough to battle the cancer itself. However, the point still remains that the plan Edwards proposes still doesn’t guarantee success; rather it guarantees higher costs.

    A quick answer to your main point. What about the possibility that we shouldn’t find and treat? Sure, we could spend hundreds of thousands of dollars trying to treat a disease, but is it worth it? For example, I could spend 30 hours a week working out and spending hundreds of dollars more eating healthier, but is it worth it? Edwards doesn’t seem to come across as thinking of the opportunity cost of his preventative care. If I misread that then maybe our disagreement is not as substantial.

  • http://dangerouslyidealistic.blogspot.com/ UCrawford

    Oh, I think Edwards is well aware of the costs of his program, he’s just not interested in informing anyone else about them. The man absolutely drips slime and his only interest is getting into the White House at any cost…he doesn’t particularly care about doing things that are good for the country when he gets there. He’s just another hack with a platform designed to appeal to stupid people.

  • Chepe Noyon

    OK, trumpetbob15, it’s probably better to concentrate on the many fundamentals on which we agree rather than quibble over details. I certainly agree that the health care crisis is primarily due to the distorting effects of the tax code, and that the best solution would be the gradual elimination of those distorting effects. We’re now reduced to arguing over all sorts of plans that patch over the problem rather than solving it. And I suppose there’s a reasonable argument as to whether the Democratic plans do more harm than good.

  • http://www.lunchworks.net Jeff Molby

    We’re now reduced to arguing over all sorts of plans that patch over the problem rather than solving it.

    I would untie the knot, rather than “patch over” it.

  • Quincy

    Chepe –

    I think you’re being too generous when you say, “And I suppose there’s a reasonable argument as to whether the Democratic plans do more harm than good.”

    The analysis of the root problem shows clearly that further centralizing control, as the Dems are wont to do with health care, would absolutely do more harm than good. As I said earlier: [Edwards] seeks to replace a system where the consumer is ignored in favor of the employer, who at least is somewhat influenced by consumers (who can always seek another job), to the government, which has police power over those same consumers. In terms of responsiveness, does this at all seem like a good idea?

    The problem here, with health care, is too many barriers between health care providers and consumers making mutually-beneficial arrangements based on their own needs and preferences.

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