mercredi, décembre 12, 2007

Well, It's Better than Nothing

This is the first in a series of responses to a quote from a likely caucus goer in Iowa. I heard the quote while listening to an NPR piece last week. The quote follows:

“I see a real philosophical difference between me and many of those who’ve spoken here. I want to be in charge of my healthcare. I was paralyzed. I had polio. My parents paid for that. They chose to find doctors who performed three surgeries on me. I can walk. I don’t want that dictated by the federal government, and I think what I hear is all this emotion - this tugging at the heartstrings. It’s bigger than that. What’s the federal government responsible for? It isn’t for making laws that tell me that I can’t eat trans fat. That’s my choice. That’s my choice. And, you know, I am single. I am self-employed. I make a great deal of money through my own hard work. I don’t want to pay for someone else’s child to eat breakfast at school anymore. You know, that it not the role of the federal government.”

Many questions came to mind when I heard this speaker. Among them was...

Should the government play a role in healthcare?

In August of 2006, the Census Bureau released data showing that in 2005, 46.6 million Americans were uninsured. This translated to 15.9 percent of Americans. The 2005 number represented an increase of 1.3 million uninsured over 2004. The number of children who are uninsured rose from 7.9 million in 2004 to 8.3 million in 2005. Source

In the most recent data I could find, an additional 16 million people are underinsured. Among those who are underinsured, 54% percent report going without needed care and 46% report being contacted by collection agencies seeking payment against health care bills. Source

Now, I can (and do) understand that a number of people have the Horatio Alger/Ronald Reagan belief that if you work hard and make good choices, then you’ll prosper. Those same people also feel that if, in spite of your earnestness and zeal, you do encounter difficulties, then you should not turn to the federal government for help. That’s a role for family and churches and charities.

There are at least six flaws to this argument:

1. Not everyone is blessed with the same talents and resources. Even if all of us had the same work ethic and the same desire for independence, we cannot all be CEO’s or self-employed superstars. All economic models count on it, but especially our pseudo-capitalism. Some occupy lower wage positions, so that goods and services we purchase at market are affordable for all of us. For example, someone has to cook fast food (and someone has to do it during school hours when teenagers are unavailable), and those who cook fast food cannot be paid six figure incomes – Big Macs would cost a fortune.

2. Earnest, hard-working, zealous people sometime encounter situations where, through no fault of their own, they lose insurance and still require care. The NPR piece from which the quote above was taken, started with a woman discussing her experience with breast cancer. She said that she lost her job and her insurance while undergoing treatment. Friends held a fund-raiser to help her with her medical expenses. Those who argue that the government has no role in health care or health insurance must imagine a world where there are a lot of garage and bake sales. In the end, no one seems to argue that there’s no void to fill, the argument is about how best to fill it.

3. People who do not have insurance or are underinsured tend to wait for care. While they wait, their treatment becomes more complex and more expensive. At a certain point, even the coldest and meanest hospital will not turn them away; they are given the care they need. That care, once provided, is added to the cost of care for those who are insured. In most cases, doctors get paid whether the patient pays or not. [This also works in for plastic surgery. Surgeons charge a premium for breast augmentations so that from time to time they can do reconstructive surgery on a pro bono basis.] What this means is that either way, you pay. It’s just that in the status quo, you pay more because a health issue that could have been addressed at a lower cost when it was minor is now a major problem, and an expensive one to boot.

4. People like me, who support a single payer health insurance model, do so because we see cost efficiency in creating a very large group of insured. In this model, the healthy who consume few health care services subsidize the care provided to the sick (the way all insurance works – those who make it through the year without car crashes help pay for those who do not). Only there is a very large pool of healthy people to minimize the overall costs.

5. Those who argue for the status quo have no solution for three fundamental problems we experience today – (a) the tendency of rising healthcare costs to outpace inflation by a significant margin, (b) the resulting increase in insurance costs, and (c) the reality that an HMO may deny your prescribed treatment (or refuse to pay for it). These two phenomena illustrate fundamental flaws in the current model.

6. Last, if you strip it all away, you’re left with two things: philosophy (“that’s not the role of the government”) and mistrust (“I don’t want the federal government interfering in…” or, “the federal government will make a mess of it…”). But you can’t treat catastrophic ailments with philosophy. And even under the single payer model, no one envisions an end to an individual’s right to obtain their own insurance and their own care on their own terms. [I’m also tickled that those who have problems with the federal government devoting dollars and resources to insuring everyone, seem to have less of a problem with the $475 billion dollars (and counting) we’re spending in Iraq.]

Heartstrings or no, we end up paying anyway. Let’s treat minor ailments before they become major illnesses. Let’s see that everyone, especially children, is insured. Let’s leverage our ample resources and our government infrastructure to insure the uninsured and adequately insure the underinsured.

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