Who Decides on Health Care? – Hobart and William Smith Colleges \
The HWS Update

Who Decides on Health Care?

Having tackled civic engagement, international service, environmental policy, religion and youth politics, the President’s Forum, in the final lecture of the 2009-2010 academic year, turned to health care.

Providing a counterpoint to previous President’s Forum guest Howard Dean, Michael Tanner, a senior fellow at the Cato Institute, brought to bear, as HWS President Mark D. Gearan said, “a broad and deep understanding of U.S. domestic social issues.”

In his talk, titled “What Now for Health Care,” Tanner looked at the components of the bill and its implications on our economy and medical and insurance practices; first setting the context for the bill-the innovation, quality and choice in the U.S. system-and the problems with the current system-the cost, the distribution of services and others.

“I believe that if you are sick, this is the place you really want be,” Tanner said of the U.S.  “We want to make sure reform doesn’t undermine the things that are good about our system.”

On the costs of health care, Tanner said that because, from an economist’s standpoint, the U.S. does not have a functioning market for health care, it is difficult to gauge what a reasonable percentage of the GDP to spend on health care would be.  He examined the discrepancies in the estimated figures of uninsured Americans, citing those eligible for benefits who have not signed and those who can afford health care but do not purchase it, among others, and the disparity in the quality of coverage among Americans.

“Distribution of cost is a problem,” Tanner said.  “People can’t access health care  because they can’t afford it.  The quality of care is uneven, and we need to work on spreading it.”

After breaking down the components of the bill into their major parts-individual mandate, employer mandate, insurance regulation, insurance exchange and subsidies and medical expansion-and examining their benefits and costs, Tanner put to the Geneva Room audience a question.

“This debate,” he said, “boils down to a single question, like anything in politics.  ‘Who decides?’  If you think about this question and answer it, I think many of the questions about this bill will be answered.”

As the former director of research of the Georgia Public Policy Foundation, former legislative director for the American Legislative Exchange Council and now at the Cato Institute, Tanner has been examining policy issues for decades.

At Cato, he heads research into a variety of domestic policies with a particular emphasis on health care reform, social welfare policy, and Social Security.  Under Tanner’s direction, Cato launched the Project on Social Security Choice, which is attempting to transform the Social Security system into a private savings program. Time magazine calls Tanner, “one of the architects of the private accounts movement,” and Congressional Quarterly named him one of the nation’s five most influential experts on Social Security.

His most recent book, “Leviathan on the Right: How Big-Government Conservatism Brought Down the Republican Revolution,” chronicles changes in the Republican Party as it has shifted away from its limited government roots and warns that reform is necessary to avoid continual electoral defeat.  His other books include, “Healthy Competition: What’s Holding Back Health Care and How to Free It,” “The Poverty of Welfare: Helping Others in Civil Society,” and “A New Deal for Social Security.”  Tanner’s writings have appeared in nearly every major American newspaper, including the New York Times, Washington Post, Los Angeles Times, Wall Street Journal and USA Today.  

Established in the winter of 2000 by President Mark D. Gearan, the President’s Forum Series is designed to bring a variety of speakers to campus to share their knowledge and ideas with students, faculty and staff of the Colleges, as well as with interested community members.