Lowdown on Lowden

LOWDOWN ON LOWDEN…. Sue “Chicken for Checkups” Lowden clearly didn’t have a very good week. The Republican Senate hopeful became something of a national laughingstock with her livestock-centered approach to health care delivery. “Let’s change the system and talk about what the possibilities are. I’m telling you that this works,” Lowden said on Monday. “You know, before we all started having health care, in the olden days, our grandparents, they would bring a chicken to the doctor. They would say I’ll paint your house…. Doctors are very sympathetic people. I’m not backing down from that system.”

Democrats are anxious to keep this story alive as long as possible, and they’re having some success. Nevada Dems, for example, held a protest yesterday outside Lowden’s campaign office in Reno. It came just hours after some very clever folks launched a new website: “The Lowden Plan, a simple health care plan anyone with a few thousand live chickens can use.” There’s a very helpful Lowden Plan Medical Chicken Calculator on the site.

But as entertaining as this is, there’s a related policy observation that shouldn’t go overlooked. Paul Krugman explained late yesterday:

Sure, it’s funny to see a 21st-century political candidate pining for the days of a barter economy. But [Lowden’s] remarks would have been breathtakingly ignorant even if she had called for payments in cash.

The key fact about health care — the central issue in health care economics — is that it’s all about the big-ticket items. Checkups don’t cost much; neither does the treatment of minor illnesses. The money that matters goes to bypasses and dialysis — costs that are highly unpredictable, and that almost nobody can afford to pay out of pocket. Modern health care, if it’s going to be provided at all, has to be paid for mainly out of insurance.

Conservatives don’t like this; if few of them propose paying in chickens, there is nonetheless a constant refrain of calls for making the market for health care more like the market for bread, with consumers paying out of medical accounts and engaging in comparison shopping.

Why this preference for cash? Because even conservatives know in their hearts that insurance markets are deeply imperfect, which means that standard free-market arguments become very weak once insurers are involved. And so they pretend that we don’t really need all that insurance.

It’s been lost in the shuffle, but Krugman’s description of the GOP line is absolutely right. Indeed, as Lowden became a national punch-line, the Nevada Republican Party predicated its defense of the Senate candidate on exactly this point: Lowden’s over-arching concern is that Americans rely on health insurance to help cover medical bills, and that’s a bad thing.

Nevada GOP communications director Ciara Turns told Eric Kleefeld the other day, “[Lowden] was clearly trying to make the point that if we moved away from an insurance-based system and more people started paying cash for their health care, then prices would come down. But [Democrats] don’t want to address that … because it’s a legitimate point that they can’t argue.”

Now, looking specifically at the plain wording of Lowden’s argument, she was specifically (and repeatedly) talking up the notion of bartering, not bargaining. Turns’ interpretation is generous, to put it mildly.

But even if we accept the defense at face value, as Krugman explained, the underlying policy dispute is hardly any better for Lowden and the Nevada GOP.