Bi-Weekly "Metapolitics" Discussion - Intro to Healthcare Reform

Details

The weather forecast for Sunday looks good, so I've scheduled our meetup for Washington Square Park again, between 6th & 7th Streets on Walnut in Olde City. The weather forecast says it should be clear & sunny with temperatures in the lower 80s, but there's plenty of shaded areas in the park that should still be comfortable. If you don't want to sit on the grass, just bring a folding chair or picnic blanket to sit on. (I have a few extra folding chairs I'll bring, but I don't have enough for everyone.) You can also bring any type of food or drink you want, although I don't think alcohol is allowed in the park.

(If the weather changes, our fallback spot will be Café Walnut, which is right off the square at 703 Walnut Street.)

The park is fairly easy to get to if you're using public transit. With SEPTA, take the Market-Frankford Line & get off at the 5th Street Station (corner of 5th & Market), and walk 2 blocks south on 5th and then turn right on Walnut Street and walk 1 block west. With PATCO, just get off at the 9th-10th & Locust stop and walk 3 blocks east. For those who are driving, parking in the neighborhood can be tough to find. If you can't find a spot on the street, I'd suggest parking in the Washington Square parking deck at 249 S 6th Street which is just a half block away.

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AN INTRODUCTION TO UNDERSTANDING HEALTHCARE REFORM

This meetup will explore the debates over the last decade on healthcare reform and will try to provide a broad, bird's-eye-view of the subject and a general sense of the expert consensus on the psychological factors & logical fallacies that distort our healthcare debates, the economic consensus on various healthcare issues, and an objective ranking system for the healthcare systems of various countries.

The videos you see linked below are intended to give you a basic overview of the psychological factors that influences the average person's view of healthcare, as well as the expert consensus in moral philosophy, economics, and international healthcare analysis. As usual, I certainly don't expect you to read all the articles prior to attending our discussion. The easiest way to prepare for our discussion is to just read my notes & watch the videos linked under each topic, which come to about 44 minutes total. The articles marked with asterisks are just there to supply additional details. You can browse and look at whichever ones you want, but don't worry - we'll cover the stuff you missed in our discussion.

In terms of the discussion format, my general idea is that we'll address the 4 topics in the order presented here and we'll spend about 30 minutes on each section.

POLITICAL PSYCHOLOGY & HEALTHCARE: HOW DO DIFFERENCES IN OUR PERSONALITY TRAITS & MORAL FOUNDATIONS SHAPE OUR DIFFERENT POSITIONS ON HEALTHCARE? HOW CAN THE LIBERAL EMPHASIS ON ALTRUISM & THE CONSERVATIVE EMPHASIS ON PERSONAL RESPONSIBILITY GO AWRY? WHAT PSYCHOLOGICAL FACTORS CAN ACCOUNT FOR PEOPLE FLIP-FLOPPING ON CERTAIN HEALTHCARE ISSUES, LIKE THE INDIVIDUAL MANDATE?

1a) Luis Figueroa w/ Robin Hanson, "Healthcare & Showing That You Care" (video - 9:54 min.)

https://www.youtube.com/watch?v=4i6LcQh--GU

1b) Jo Usmar, "The Number 1 Fact About Obesity Is Wrong" (video - 4:12 min.)

https://www.youtube.com/watch?v=oq-AkTyQprc

Matthew Trost, "The healthcare debate: Jonathan Haidt on how our moral roots skew our reasoning" (short article)

http://blog.ted.com/the_healthcare/

Ezra Klein, "Unpopular Mandate - Why Do Politicians Reverse Their Positions?" (medium-length article)

https://www.newyorker.com/magazine/2012/06/25/unpopular-mandate

THE MORAL PHILOSOPHY OF HEALTHCARE: IS HEALTHCARE A HUMAN RIGHT, IN THE SENSE THAT WE HAVE A MORAL DUTY TO HELP ENSURE EVERYONE RECEIVES A CERTAIN LEVEL OF MEDICAL CARE? DOES THIS MORAL DUTY GIVE THE GOVERNMENT THE MORAL AUTHORITY TO TAX CITIZENS TO PROVIDE UNIVERSAL HEALTHCARE? IF SO, SHOULD THERE BE LIMITS TO THIS RIGHT TO PUBLICLY-FUNDED HEALTHCARE (E.G. COSMETIC SURGERY, EXPERIMENTAL OR ALTERNATIVE MEDICINE, PREVENTABLE LIFESTYLE DISEASES)? ARE THERE ANY CORRESPONDING DUTIES (E.G. CONTRIBUTING A CERTAIN AMOUNT, LIVING A HEALTHY & LOW-RISK LIFESTYLE, ETC.)? HOW SHOULD WE ADDRESS THE "QUADRILEMMA" PRESENTED BY THE COMPETING GOALS OF HEALTHCARE POLICY: ACCESS/COVERAGE, QUALITY, COST & CHOICE/CONSENT?

2a) Will Cain w/ Chris Hayes & Reihan Salam, "National Review vs The Nation: Is Health Care a Right?" (video - 5:49 min.)

https://www.youtube.com/watch?v=yAxOPwofpHQ

2b) Gary Chartier, "Radical Health Care Reform: An Anarchist Approach" (video - 10:18 min, listen til 6:00)

https://www.youtube.com/watch?v=ReESBM65t7M

ProCon.org, "Should All Americans Have The Right (be Entitled) To Health Care" (long series of short excerpts from speeches)

https://healthcare.procon.org/view.answers.php?questionID=001602

Stanford Encyclopedia of Philosophy, "Justice and Access to Health Care" (long article)

https://plato.stanford.edu/entries/justice-healthcareaccess/

Aaron Carroll, "The Iron Triangle of Health Care: Access, Cost, and Quality" (short article)

https://newsatjama.jama.com/2012/10/03/jama-forum-the-iron-triangle-of-health-care-access-cost-and-quality/

Loren Lomasky, "Beyond Obamacare: The Seven Percent Solution" (short article)

http://bleedingheartlibertarians.com/2017/04/beyond-obamacare-seven-percent-solution/

WHAT IS THE EXPERT CONSENSUS AMONG ECONOMISTS ON HEALTHCARE POLICY? WHAT TYPES OF REFORMS DO THEY SUGGEST? ONCE WE FACTOR IN THE SLIGHT LIBERAL BIAS (~60% OF ECONOMISTS IDENTITY AS "LIBERAL") WHAT'S THE VALUE-ADDED COMPONENT OF THEIR EXPERT OPINION?

Adriene Hill & Jacob Clifford, "The Economics of Healthcare" (video - 10:25 min.)

https://www.youtube.com/watch?v=cbBKoyjFLUY&t=29s

The Weighted Responses from the IGM Experts Panel on Healthcare:

97% of the IGM economists disagreed that "There are no consequential distortions created by the tax preference that favors obtaining health insurance through employers." (Nov. 21, 2011)
http://www.igmchicago.org/surveys/healthcare
83% of the IGM economists agreed (and 13% were uncertain) that "Loosening current licensing restrictions on the range of services that nurses, physician assistants, dental hygienists and pharmacists are permitted to perform would help patients on balance, because the additional safety risks would be small compared to the decreased costs in waiting time and fees." (Feb. 29, 2012)
http://www.igmchicago.org/surveys/health-care-licensing."
91% of the IGM economists agreed that "Long run fiscal sustainability in the U.S. will require cuts in currently promised Medicare and Medicaid benefits and/or tax increases that include higher taxes on households with incomes below $250,000." (July 18, 2012)
http://www.igmchicago.org/surveys/healthcare-and-taxes
45% of the IGM economists agreed, 21% were uncertain, and 34% disagreed that "Taxes or bans on large bottles of soft drinks containing sugar are not likely to have a significant effect on obesity rates because people will substitute towards consuming excessive calories in other ways." (Aug. 7, 2012)
http://www.igmchicago.org/surveys/obesity-and-soft-drinks
63% of the IGM economists agreed (and 17% were uncertain) that "The method that President Obama enacted in the Affordable Care Act — reducing Medicare-related payments to private insurers and altering the payment system for doctors and hospitals — imposes risks on future Medicare patients because over time the supply of doctors, hospitals and insurers willing to offer them health services may decline in response to restrained payments." 87% of the IGM economists agreed (and 8% were uncertain) that "The method that Governor Romney advocates — giving future seniors a fixed payment for premiums and letting private insurers compete with Medicare — imposes risks on future Medicare patients because competition may not be powerful to enough to offer future seniors the same quality of care that is currently promised without supplementing their premium support." (Oct. 23, 2012)
http://www.igmchicago.org/surveys/medicare
57% of the IGM economists agreed (and 27% were uncertain) that "A market that allows payment for human kidneys should be established on a trial basis to help extend the lives of patients with kidney disease." (Mar. 11, 2014)
http://www.igmchicago.org/surveys/supplying-kidneys
100% of the IGM economists agreed that "Declining to be vaccinated against contagious diseases such as measles imposes costs on other people, which is a negative externality." 89% of the IGM economists agreed that "Considering the costs of restricting free choice, and the share of people in the US who choose not to vaccinate their children for measles, the social benefit of mandating measles vaccines for all Americans (except those with compelling medical reasons) would exceed the social cost." (Mar. 10, 2015)

http://www.igmchicago.org/surveys/vaccines

63% of the IGM economists disagreed (and 30% were uncertain) that "Expanding health insurance to more people through the ACA’s public subsidies and Medicaid expansion will reduce total healthcare spending in the economy." However, 78% of the IGM economists agreed (and 19% were uncertain) that "Expanding health insurance to more people through the ACA’s public subsidies and Medicaid expansion will generate gains in the health and well-being of the newly insured that exceed the costs." (Oct. 5, 2015)

http://www.igmchicago.org/surveys/health-insurance-subsidies

84% of the IGM economists agreed that "The 'Cadillac tax' on expensive employer-provided health insurance plans will reduce costly distortions in US health care if it is allowed to take effect as scheduled in 2018." (May 17, 2016)
http://www.igmchicago.org/surveys/cadillac-tax

The Responses from the National Association of Business Economists (NABE) on Healthcare:

"More than two-thirds of business economists say consumer driven health insurance is either very important or extremely important in lowering health care costs and improving the quality of care, according to a survey released today by the National Association of Business Economists (NABE)... Consumer driven plans give employees economic incentives to make prudent decisions in choosing a health plan and in consuming medical services. They usually involve an MSA or Health Reimbursement Account (HRA), from which employees spend on routine health care needs and save what they do not spend." (Aug. 2003)

http://www.ncpa.org/media/ncpa-business-economists-endorse-consumer-driven-health-care

"A slight majority of survey respondents (51%) states their general opinion of the Affordable Care Act (the ACA, or “Obamacare”) is favorable, whereas 43% have an unfavorable opinion. A larger majority (55%) favors replacement with a system that “increases consumer choice and control, supported by tax credits.” Only 17% favor a system that “increases government influence over prices and services,” and 22% indicate that the ACA has struck a reasonable balance and should be essentially preserved." (Mar. 2017)

http://files.constantcontact.com/668faa28001/a66e9b66-7729-4209-8e9b-c7d1386e8853.pdf?ver=1488578564000

"The panel has concerns about health care policy, but is generally not alarmed. Survey respondents were asked to score the seriousness of instability in the private health care market on a 1-to-5 scale, with 1 indicating not a problem, 3 indicating a limited, manageable problem, and 5 indicating it is a fatal problem. The average of survey results is 3.6. The panel was also asked to score the need for health care reform legislation on a 1-to-5 scale (1=not urgent at all; 3=somewhat urgent; 5=very urgent); the average score is 3.7. Still, survey respondents indicate that the chance of “meaningful” health care legislation 2017 is low, with only a 10% median probability of action in 2017. The median probability of action in 2018 is 20%." (Aug. 2017)

http://files.constantcontact.com/668faa28001/0a267cb2-8a9f-4cfe-8dff-141e54f50343.pdf?ver=1503088258000

IS THERE A RELATIVELY OBJECTIVE WAY TO RANK THE HEALTHCARE SYSTEMS OF VARIOUS COUNTRIES IN TERMS OF COST-EFFECTIVENESS & OVERALL QUALITY? JUDGING BY THE VARIOUS TYPES OF HEALTHCARE SYSTEMS IN DEVELOPED COUNTRIES, WHAT IS THE RANGE OF POLICIES THAT LOOK FAIRLY SUCCESSFUL? DOES IT APPEAR THAT COUNTRIES WITH UNIVERSAL HEALTHCARE LAG IN INNOVATION OR ECONOMIC GROWTH?