I came across some questions by Fort Wayne Libertarian, Robert Enders, on health care, and felt compelled to try to offer some answers.
Q: If the current economic situation means we need to fix healthcare, does it follow that we won’t need to fix it if the economy improves?
A: No. We needed to fix it before. That need is simply more acute now. Our health care problems are like an albatross weighing us down.
Q: Is increasing federal spending by hundreds of billions a year on top of what we already spend somehow a better idea now that we’re 11 trillion in debt?
A: No. We should have done this before. It should have been a higher priority than Iraq, tax cuts, or some of our other spending choices. But, that ship has sailed. We need to fix our health care system.
Q: Aren’t they putting the cart before the horse? Isn’t the way to make healthcare more affordable is to grow the economy so that more people can afford it?
A: No. When the economy was booming in the 90s, our health care system still gave us too little for too much, and we did not make much in the way of progress of having more people afford health care.
Q: Isn’t healthcare’s real problems caused by previous attempts to fix it?
A: No. Best I can figure, our “real” problem is that health care doesn’t respond well to market forces because, among other things, a) prices aren’t transparent; and b) the potential purchaser is frequently in no position to bargain because of lack of options and because the subject matter is too complex for the average consumer to form a truly informed opinion.
And, while I’m on the subject, I recommend this column appearing in the Denver Post yesterday entitled “Debunking Canadian Health Care Myths.” From someone familiar with both systems comes the opinion that the Canadian system works better than the system in the United States and some of the scary stories told by those comfortable with the system in the U.S. just aren’t true.
Thanks for the link to the Canadian story. I work with quite a few people who moved to Indiana from Canada for work. They have all said the same thing as the author of this article.
daron
Obama has a lot of work to do cutting through the ideology and spin.His best venue is town meetings answering questions at random.Right now,as I see it, he has to debunk the ‘we don’t want socialism’ spin.He also must put the huge and growing deficit into a perspective that health care reform will help by lowering.
As I understand the caveats from the right,we can’t have a public health care program because it would offer a better deal and everyone would rush to sign up for it,leaving private insurance with few subscribers.Surely President Obama can unspin that. Why can’t we seek to strike a balance between private and public offerings? Most people aren’t ideologues and just want a system that offers honest choices and that works,once a plan is chosen.
President Obama himself must explain these issues many times in many venues and answer unfiltered questions in open forums. He must overcome the blogs, which are so often catechisms for already avid believers.
Without some restraints a national health care that is to be everything for everybody will break the bank. While medical advancements are continuing to occur at a high rate the research and development are very expensive–we are already at a point where keeping a person alive for a very long period (the point of keeping a cadavar “alive”) can be very very expensive—will we all be willing to pay the price. Does everyone get to have every treatment they want or is available? Is $500,000 for a cancer patient too much to spend on one person? Do we spend the same for a 5 year old as a 95 year old? Simply very concerned that all the hype for a national health plan could be beyond what is real world.
Imagine if health care were not tied to your job (i.e. affordable independent health insurance, universal/socialized health care, etc.). People who could retire would retire, instead of holding on in order to have health insurance. That would open up a number of jobs to the unemployed. How many people would start their own business if they didn’t have to worry about health care? Fixing health care would have a very positive impact on the economy and society.
It’s tied to our jobs because we can get it– and firms can provide it– on a subsidized basis. Since it is a non-taxed form of compensation, we prefer to get some of our comp in the form of tax-free (subsidized) benefits!
All of this misses the real reason why socialized medicine is absolutely unacceptable: it’s immoral, and a wholesale trampling of sacred natural individual rights.
Nothing else matters.
It’s unconstitutional, unethical, and impractical…other than that, it’s a great idea!
The current system of heavy government intervention is also an UU&I mess.
It’s immoral to trample on peoples’ right to not have access to medical care. It’s like rape or murder.
Interesting observation thus according to this line of thought–we the people are entitled to life, liberty, and pursue of happiness plus all wanted/needed medical plus cheap money to buy whatever we want/need plus low taxes plus all services the government could possibly provide of course at no cost to us but paid by someone else. Interesting!
Is it constitutional for the Government to regulate health care? I think so. In any case, its been done for a long time, and I don’t think that’s going to change — any more than we’re retroactively going to decide it was unconstitutional to make the Louisiana Purchase or engage in any number of military adventures without a declaration of war. It might be intellectually interesting to talk about the constitutionality, but I think we’re in “a little bit pregnant” territory with this one.
I think the most important issue at this point is the utility of the system we adopt. That brings us to question #2. Can we afford government subsidized health care? Depends on what we’re buying. Right now, our health care system looks horribly inefficient. We’re like a steam engine with the boiler belching out a bunch of heat and steam and water that’s doing nothing to move us forward.
At the moment, our health care system spends a ridiculous amount on bureaucracy — according to that column cited, it’s 31% of health care dollars spent in the U.S. versus 1% overhead in Canada and 3% for Medicare.
I’m no expert, so I don’t know what the final product is going to look like. But, items I’m fairly confident about are that a) the system needs to change because the one we have is lousy and it’s hurting us; and b) it isn’t going to change unless government is heavily involved. As long as we’re dependent on medical insurers that regard health care dollars spent on actual medical care as “medical loss,” we’re going to continue to continue to get less for more.
Doug- What do you think about the Enumerated Powers?
I think they’re good ideas, but mainly just theoretical at this point, given the expansive interpretation of the commerce clause.
There was an American history text book that spent a lot of time talking about Hamilton’s view of a strong federal government versus Jefferson’s view of a limited federal government. The chapter after the Civil War concluded opened simply: “Hamilton won.”
In practice, I would have little choice but to agree. That said, it’s never too late to reverse course. Imagine if our country had said, “we’re a little pregnant” on slavery, or, “the ship has sailed” on slavery. Intolerable, no?
And if you think that health care is inefficient now with elective insurance-driven care, how much less efficient will it be should Kennedy-Dodd pass mandated insurance-driven care? Will costs go down? IMO, insurance is the biggest part of the problem: a middleman skimming a large percentage for bureaucratic and clerical ‘efforts’, plus telling care providers, “We’ll pay up to ‘x’ amount”, thereby ensuring that costs magically rise to ‘x’ amount.
This noise about access is crap. Go to an ER and you’ll find uninsured people there with cramps and headaches. If anything, that’s a good demonstration of too much access, and wasteful allocation of resources.
Constitutionality is irrelevant, as the proper role of government and scope of its actions are metaphysically independent of and prior to the Constitution (or any other document written by men, for that matter).
I agree with you that insurance seems to be the problem. (Also, I’m mindful of my history teacher’s proclamation that today’s reforms are tomorrow’s corruption).
ER access is the wrong kind of access. How much should it really cost to tell someone “you have a headache – drink some water and maybe an aspirin”? How much do you figure those people you describe actually get billed? (And, of course, how much they actually pay is yet another question.)
So, I’m not doing much more than repeating that I think the current system is FUBAR. And I don’t think market forces are going to fix it. Will the non-market government force fix it? Probably solve some problems and cause others. But, because the bar is currently set so low, I think it will do more good than harm.
Not that I don’t have my fears. What if we spend a ton of money and get to wrestle with a bunch of paperwork for the pleasure of dealing with the medical equivalent of Patty & Selma?
Kurt said “metaphysically”. Snort, chortle.
Did you mean that as “Supernatural” or “Theoretical”?
Sorry, but in this country “constitutionality” is very important at the level that is being discussed, IMO.
The latter
And what’s typical in “this country” is irrelevant; if people in “this country” argue from the wrong starting point, then they need to change so they are arguing from the CORRECT starting point.
As a practical matter, would some form of full-blown govt system (as proposed) be worse than a heavily-influenced govt system (as now)? We can make some good guesses: less paperwork, longer lines and other cost rationing, etc. But no one knows.
In any case, the first thing in analyzing and wrestling with that question is to recognize that the govt is very heavily involved now through a variety of huge policy choices– from the devastating impact of the subsidy for insurance to more modest policies like state mandates to cover marginal services.
Instead, most people believe somehow that we have a “free-market health care system”.
Mike–
Good observation about access to the ER. Unfortunately, people go to the ER because they either don’t have access to cheaper, convenient healthcare, or at least they perceive they don’t. So rather than go incur a $60 charge at a doctor’s office, they go get the $1000 ER workup, which is then reduced 90% based on a sliding scale (at least that’s how it works here in Tell City).
Some people just won’t wait, no matter how serious the problem actually is. There have been weeks where my three hour Saturday clinic has accounted for a quarter of my business that week, while denying the ER $30,000 in charges (or more).
In the end, do we want to subsidize clinic care for the uninsured, or ER care? And do we want to continue to spend 30% or more of our own insurance premiums on overhead?
While the remark is not original with me it does seem called for now. “The only way to avoid becoming a metaphysician is to say nothing”. If Aristotle thought enough of the subject to write a book on it and Aquinas enough of the book to use it then our day and age is the lesser for being without its many uses. Some more charitable sort could provide hundreds of examples of metaphysics in the Declaration of Independence and Constitution and even Physical Sciences go astray when they fail to deal with their own metaphysical assumptions.
Doug- There are market responses that are effective and efficient. I am thinking here of the doctors who have set up independent clinics that refuse to accept insurance. It’s ‘cash & service’ only, walk-up or appointment. There is one such clinic in Greenfield that I am aware of. The 30% or more that T refers to is eliminated.
Now, if Kennedy-Dodd passes, will places like this be essentially illegal? Quite possibly, because that bill would require, mandate that all are insured.
I think that we’ve come to treat health insurance the wrong way. Compare how we treat auto insurance. With the latter, we buy it (are mandated to, unfortunately) but hope never to use it. I myself have gone 19 years without receiving a benefit, only ever making payments. I don’t expect that every oil change is covered, nor the replacement of wipers, etc. Yet, we’ve come to expect that every office visit, every prescription, etc., is supposed to be covered by the insurance.
I use insurance the same way you do, Mike. I keep my deductibles higher because, within the deductible, I can manage the risk without insurance. Insurance should be about risk management — protecting against a financial impact you can’t handle on your own.
I used that plan when we had our daughter — regular costs of birth weren’t covered, and I was o.k. with that because: a) it wasn’t a risk – it was a planned expense; and b) normal labor costs were within my means. My policy protected against complications of birth. As it turned out, my wife had to get a C-section because my daughter’s heart rate spiked during the delivery. That could indicate, but didn’t as it turned out, a blood infection. Such an infection was covered by our insurance policy. But, I had to go to war with my insurer – poring over my insurance policy, doing legal research, and consulting with my doctor buddy. (Thanks T!) They initially took the position that this was an elective C-section and not covered, but they eventually coughed up. I don’t know what people with fewer resources do in that situation other than go bankrupt or pay a lot of money.
But, in a sense, I got lucky. I didn’t know in the heat of the moment what the specific language of my policy was — my understanding, based on conversations with my agent, was that it covered “complications of birth.” It turns out it was more specific than that and, luckily, our situation fell into one of the covered complications and I had the ability to force the insurer to honor the policy.
When my daughter’s heart rate spiked though, my wife and I were in no position to go shopping. All I could really do was accept the doctor’s advice and have the C-section performed. I had been, I think, reasonably prudent, and I was about a hair’s breadth away from a huge financial setback.
That’s just one story, so I’m not sure how much broader applicability it has. It would certainly be helpful if prices for various services were more widely known. A scheduled doctor’s office visit, for example, is much more reasonable than I would have guessed. If folks knew that they were probably choosing between a $70 office visit to nip something in the bud versus a $3,000 emergency room visit when things got too bad to ignore, maybe they’d choose the $70 visit more often.
True insurance deals with rare, catastrophic events; it does not deal with planned or common events. This speaks to Doug’s example: rare, above-and-beyond, massive problems would be covered. Cancer, yes; allergy shots, no. And so on.
Mike’s analogy to autos and auto insurance is on-point here.
What we have now– because of the subsidy on health insurance– is far too much coverage. Thus, we have coverage that is far too expensive, inflates costs (since we don’t care what stuff costs), messes up portability (since it’s tied to our jobs), increases paperwork (since we have paperwork for the equivalent of every oil change and door ding), and so on.
While I’m not a huge Michael Moore fan, seeing his film “Sicko” definitely changed my perspective on health care. I tend to lean toward a conservative/libertarian way of thinking when it comes to politics, but socialized or quasi-socialized healthcare is an issue I feel very strongly about. Thanks for the link to the great article; I’ll definitely be forwarding this on to friends and family members.
-Jay
Moore’s film was both better than I expected– and not nearly the call to socialized medicine that I expected…
http://schansblog.blogspot.com/2008/04/sicko-lot-healthier-than-i-expected.html