Thursday, July 23, 2009

health care - 2 arguments

I am fascinated that there are two arguments circulating against a government sponsored health care plan... two arguments that conflict with each other. Let me address both of them.

The first is that the government can't do anything well so we can't allow them to do something as important as health care. A sub argument of this is that or system is already "the best in the world."

Let's get rid of the sub argument. According to the World Health Organization the US ranks37th in the world, just between 36- Costa Rico and 38, Slovenia. France is 1 and Italy is 2. We are still behind such countries as Singapore (6), Morocco (29), and Chile (33). We have huge number of folk uninsured who have no access to health care at all until they go into the emergency room and then are paid for by the rest of us. And very few of us have adequate health insurance. A few years ago my daughter needed surgery. Without it, she would have chronic pain in her jaw, eventually would lose her hearing, and would have her jaw lock occasionally which would have to be broken to unlock. Our incredibly expensive insurance didn't cover the procedure regardless of the prognosis without it. We were faced with the decision of paying out of pocket or watching that unfold. My daughter carries a new BMW in her mouth. In 2007, 62% of bankruptcies are related to health care costs.

I am always surprised that the same folk who argue against government sponsored health care are happy to rely on government sponsored police protection, fire protection, military, and roads. You can't have it both ways. Either the government is completely inept and shouldn't be doing those things either or you have to allow that government can do some things well. Indeed, there are some things that only government can do well.

Now some would say that they don't want a government bureaucrat making decisions regarding who gets what tests, etc. The problem is that under the current for profit insurance system, a bean counter makes those decisions. For the government employee, at least the primary concern is the public good. For the bean counter, the only concern is maximizing profits. At the bottom line, and it is about the bottom line, they are trying to cover as little as possible so as to spend as little as possible and keep as much as possible of your and my insurance premiums. We learned that with Alexis' surgery. Give me the government bureaucrat any day.

Will some decisions be made that we don't like? Yes. Will some procedures be denied? Yes. Is that different than now. No. The difference is the motivation for denial. Currently it is because of a profit margin. Then, it will be because of projected outcomes.

The second argument against a public option, is that the insurance companies won't be able to compete. Understand that. The government program will be cheaper and better so the insurance companies will not be able to provide the same service at as low a price. I love it. The government program will be too good. And that is an argument against government sponsored health care?

OK, the argument is a little more subtle than that. It goes like this. The government program will be so good and so cheap that the private companies will no longer be able to compete and will go out of business. Eventually there will be no competition and the government program will become sloppy and quality and price will suffer. This argument again ignores the current reality. Almost none of us shop for insurance. If you get it through your employer, they provide what they provide. Take it or leave it. And in large degree, they make contracts based on cost or availability. I get my health insurance through my church. It is ridiculously expensive. It s also the only option we have. If you don't get insurance through an employer, I'll bet you don't have any. Likewise regarding physicians, labs, etc. I get a list... a small list from my insurer and that is where I go. Sometimes there is one name. Sometimes, for some specialties, there are none. I know nothing about any of them and have no way of knowing anything about any of them. So much for choice or competition.

Another piece is the "bad word" - socialist. We can't have socialized medical care. First off, the only country I'm aware of with true socialized medicine - that is where the government owns the hospitals and clinics and the physicians and nurses are government employees - is Great Britain (number 18 on the list). Other countries have socialized insurance where the government provides a single payer insurance and the physicians/hospitals/etc. are private vendors. The difference is one insurance company with all of the economies of scale and the motivation of the public good vs. a system of multiple insurance providers with different rules, providers, and the primary motivation being profit rather than the public good.

There is another argument... and it is the saddest one of all. If we suddenly provide health care for everyone, there won't be enough doctors and facilities. This is always an argument from someone who has health insurance. The bottom line here is, "I have mine, so *%#* you if you don't have yours." It is a real concern but the answer is not to ignore the needs of so many, it is to change the system so we train more healthcare professionals. They do it in every other civilized nation in the world. Why not here?

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