Questions on health care to ask a senior fellow at the Cato Institute

November 23, 2009 1:09 PM

What are some respectful, substantive, and incisive questions to ask a senior fellow of the Cato Institute about health care reform?

I know this is a very short-term question, although I think there will be value even after this event.

A senior fellow of the Cato Institute is coming to speak at my school about health care reform. You can imagine his position on the issues. He's an experienced talking head.

What are some good questions to ask him? They must be respectful and substantive. While I am opposed to his politics on this issue, I'm very good friends with the President of the Federalist Society out here and I don't want to embarrass either Mr. Bandow or my school.

posted by Sticherbeast to Law & Government (10 answers total)

I saw a guy from the Cato Institute speak recently about healthcare reform; perhaps it is the same person.

In any event the main point the speaker made was that he construed health insurance as neither a right nor a privilege but rather as a consumption good.

Perhaps ask your speaker to justify this position.
posted by dfriedman at 1:22 PM on November 23, 2009

Shouldn't there be some minimal government intervention in a market when the market itself is unable and unwilling to provide services to a segment of the population (as the health insurance industry is)? If no, why not? Clearly we cannot depend on "the market" to work itself out, because it has shown no willingness or ability to provide reasonable services for those unable to secure health insurance through their employer.

Alternative spin on the above: Isn't health care fundamentally different than other markets, like auto sales or computer software, where ultimately we can usually rely on the market to fix things? Isn't the health care our society receives something that should be insulated from profit considerations?

Another one: In a perfect world, would you not have health insurance tied to one's employer?
posted by midatlanticwanderer at 1:27 PM on November 23, 2009

I'd focus upon the economic stagnation caused by the current system, given that many people end up tied to jobs specifically for the health benefits. Shouldn't we strive for a system that encourages rather than limits entrepreneurialism?
posted by susanvance at 1:31 PM on November 23, 2009 [2 favorites]

Another one: the auto industry is a great case study for how the current system harms employers. Rapidly rising costs of health care were a key factor in GM's bankruptcy, for example. Likewise, in recent years global companies like Toyota have chosen to build their new plants in Canada rather than the U.S. specifically to avoid the costs of health care, particularly given that they have no control over its inflation.
posted by susanvance at 1:45 PM on November 23, 2009

midatlanticwanderer, susanvance, Cato has long advocated for the separation of health insurance from employment. The current proposals are not the only solution to that issue. Bringing up the failures associated with union-heavy industries will spur a whole different selection of commentary from them.

Don't go looking for "gotcha" questions. Think of questions along the lines of dfriedman's suggestion: Find out where your fundamental axioms are different, and have him elaborate on those differences.

I recommend reading a good selection of his essays. Cato's pretty good about collecting them for each fellow (e.g., Michael F. Cannon). Finding something particular that he has thoroughly studied will give you a much better interaction than general "Why do Libertarians hate poor people?" fodder.
posted by FuManchu at 2:47 PM on November 23, 2009 [1 favorite]

Each insurance company negotiates its prices with hospitals and other health care providers. There are a limited number of insurance consumers in a geographic area. The more insurance companies exist in that geographic area, the fewer consumers each company represents. The few consumers a company represents, the less leverage they have to negotiate prices with hospitals.

Doesn't this mean that health insurance is a special market in which more competition leads to increased costs?
posted by paulg at 2:48 PM on November 23, 2009

Id be curious about what is - personally - optimal health care scenario would look like. I honestly don't have a very clear idea about how the conservative model of health care would be. For example, would everyone be covered? Would employers continue to foot the bill? Would consumers pay a portion?

I feel for all of the bashing around Obama's plan, there isn't really another solid vision n the table. So I guess it's something like: (In your mind, if health care coverage was working, what would it look like - and what challenges are they facing in realizing that vision...)

Conversely, i'd wonder which countries they thought were doing health care right, and why.
posted by anitanita at 2:49 PM on November 23, 2009

When I imagine a completely free insurance market, it seems strongly apparent to me that a necessary consequence of such a market is that consumers can't choose to switch insurers once they discover an insurer's service doesn't live up to expectations: once you need insurance at the level required to discover whether or not it's really satisfactory, no other rational player will invite you into their risk pool without some external compulsion.

This essentially means that insurers have no direct financial incentive to compete on the actual value of and satisfaction with their service, particularly among those who need it most.

Now, indirectly, there may be secondary incentives, including:

1) legal (enforcement of contract) incentives. However, this can only serve as an effective incentive to the degree that (a) costs and penalties are more expensive than providing valuable/satisfying service and (b) consumers have sufficient resources to effectively challenge the insurer and bring the force of law to bear (while dealing physically and financial from an inadequately covered catastrophic medical event).

2) reputation. However, this can only serve as an effective incentive to the extent that (a) the cost of obtaining accurate information is within the means of most consumers and is collectively more profitable than (b) the amount of money that might be expended by insurers (and therefore made by PR/marketing) spreading favorable reputation information (accurate or not), assuming that amount of money is is less than the cost of providing valuable/satisfying service.

In other words, even these secondary incentives may be weak compared to alternatives to competing on service/value.

Given these problems, how does a free market work to provide insurance as a valuable service?
posted by weston at 2:55 PM on November 23, 2009 [1 favorite]

Michael Cannon, who FuManchu linked to above, is the Cato Institute Fellow I saw speak. Thanks for the name.

To the OP: if that is the person who you will be seeing and you would like my recollection of the speech that I heard him give, send me a MeMail.
posted by dfriedman at 3:32 PM on November 23, 2009

In the absence of universal or mandatory health insurance there is one compelling question. Who pays providers for cost of providing mandated or non-mandated emergency health care to the uninsured or medically indigent. This is currently in the tens if not hundreds of billion dollars. Right now the cost of care for the uninsured is passed along to the insured and full pay users. The cost of care ( insurance payments plus co-pays. deductibles etc) for the insured rises in direct proportion to the amount of uncompensated care and other rising health care costs. For those who oppose mandated or near universal care they must be willing to deny care, and I mean deny care, to the uninsured or medically indigent or else the cost of care for the insured continues to sky rocket. This question can be asked quite respectfully for it is a very real issue that all providers, insurers and subscribers face.
posted by rmhsinc at 7:12 PM on November 23, 2009