September 25, 2009 Leave a comment
I saw this letter to the editor posted with much praise on a forum I belong to.
Every day we consume public options
I stood in line at the post office and, as usual, someone commented about the long
line, small number of clerks and the government-run operation. Curious, I asked why
didn’t he go to FedEx or UPS. His answer: "They charge too much." Oh, I see; he
chose the public option over a private company because it’s more affordable. This
conversation made me wonder what other public options we use every day.
There are many fine private education facilities available, but the majority of
students attend tuition-free public schools. There are numerous places to buy books,
but the community uses the public library by checking out books, taking children to
story time, or using computers – all free services. So, why the aversion to a public
option in health care reform?
Health care is a moral issue, and those who espouse family values are the ones who
object the loudest. Doesn’t the woman working two jobs to make ends meet deserve
health care? Or the single mother raising her children? Or the man who lost his
factory job after 20 years of employment? Is one less deserving than another? In
this great nation, the wealthiest of nations, it’s time for all citizens to have
access to health care.
Ramona D. Marek
The problem I have with this commentary is it is completely based on emotion and not fact.
Public “Free” and “Cheap” Services
If we flip some of the arguments, we start to see glaring holes. For example, the free services mentioned are not really free, but prepaid. Perhaps we should be asking the question why people are actually buying books when there is a “free” or cheaper option available. The answer is rather complex, but generally breaks down to
- The free option is inferior. In the case of the postal service, UPS and FedEx both guarantee delivery in a timely manner; the postal service does not. In the case of public schooling, one looks at statistics. In the library, it may be in the form of out of date books (esp. in technology)
- The free option is limited. In the case of the library, the book is unavailable. No upfront cost, but there are opportunity costs for waiting for something that may take a long time.
One of the aversions to a public health care option is the fear of prepaying for an inferior and/or limited service. Looking at other “public” options, this is a realistic fear. In general, the government services are designed as stop gap measures. As such, they generally are inferior and limited in scope. But somehow we have the unrealistic expectation that health insurance reform will be different.
The author states health care is a moral issue. How does she come to this conclusion:
Decency? As a person who supports multiple charities with my time and money, I can buy into this idea.
Out of decency, I agree that we should provide health care. I propose the following.
- Charitable organizations set up foundations that provide free or low cost health care to those who cannot afford it
- Governments add to these organizations through funding or through government sponsored health care centers
- Hospitals and health centers, public and private, be mandated to aid those in times of emergency regardless of ability to pay
If we are talking decency, then the current system covers the moral imperative, as it does all three of the above. Today, one can enter any hospital in this nation and be treated for illness, both life threatening and non, without proof of the ability to pay for it.
Or perhaps she sees health care as a necessity?
Air is necessary; without it we die in minutes. Water is necessary; without it we die in days. Food is necessary; without it we die in weeks. Clothing and shelter are necessary; the length of time in which we die without these necessities can be as low as minutes in freezing climates. How long can one survive without health care? This is variable, but statistically speaking, the average person will get to the age of 65 or greater (for women) without a life threatening health care issue. This means more than 80% of the average life can be completed successfully without any health care.
But suppose we approach this as we approach necessities. When we view actual necessities, like food, water, shelter and clothing, our solutions are very different than what we are proposing with health care. Food stamps offer access to the necessity of food, but give limited choices, as the vouchers are limited in value. Housing assistance offer access to the necessity of shelter, but the type of house one can choose from is limited. In most cases, charities fill in the gaps that the government programs miss. And, today, we offer the same for medical care in the form of free clinics and regulations that hospitals cannot turn away the sick due to lack of insurance.
So, morally, even if we approach health care as an imperative out of necessity, the current systems fulfills our obligation.
Access to Health Care
The author talks about people not having access to health care, but if that is the issue, people do have access to health care, when it is necessary.
If we look at the other necessities in life, we are given access, but not the access of our choice. Our government offers us clean drinking water, but if we want non-chlorinated water, we have to buy it. Our government offers food stamps to those who cannot afford food, but if they want Ruth’s Chris they have to pay for it. Our government offers housing assistance, but not at the Ritz Carlton.
But the author does want bottled water, Ruth’s Chris and the Ritz Carlton for everyone when it comes to health care. She is not arguing for access, but for access to the doctor of her choice. She is stating that this type of access is a right and appealing to class envy to bolster her argument. But she is not really thinking through the moral imperative, access to health care, or even her analogous “free” services when she approaches this issue. It is purely emotion.
Health Care in America
When looked at objectively, we have a pretty good system. In some areas, America leads the pack. Inchildhood cancer, for example, is above the rest of the world in survival statistics. We are not the best medical system in the world, but we are not the worst.
We are, however, the most expensive health care system, per capita, in the world. Waste, in the United States, accounts for more than 50% of the total costs of health care (about 1.2 billion out of 2.2 billion). Our major health care problem is not access to doctors, but the sheer amount of waste.
The solution proposed by our government is to ensure everyone has insurance. The problem with this approach is it places a middle man in every medical transaction. When a person is not paying for what they are consuming, prices inevitably go up. In addition, when there is a middle man paying the bills, and costs go up, there is no choice but to raise rates or limit services.
There is an idealistic viewpoint that making the government the middle man will solve the problem better than insurance companies as middle men. This is unrealistic. Government really has no incentive to keep prices down, as they can reach into any number of buckets (at least for the near future). There is no reason to control costs when you can simply pass them on.
There was an article in Forbes on the waste in the health care system. Of the different areas of waste, emergency room visits is the only area moving to a government option would solve, as everyone would have access to the doctor of their choice with their government insurance card. But, one of the largest areas of health care waste is in the form of paperwork. This is primarily due to programs like Medicare and Medicaid (government run programs) which have a very high amount of paperwork compared to insurance claims. If we move to a public option, the expense of this area is likely to rise. As it is one of the highest areas for waste, the expense of health care will likely rise.
Of course, government can mandate a fee schedule, as has been pointed out to me numerous times. The problem, however, is if (or when) costs rise, the fee schedule will still rise, or you will see smart doctors getting out of the business. But, then, some have suggested not only a single payer system, but getting rid of hospitals as we know them. In this vision, all doctors are employees of the government. I am not sure how we think this will work, as most doctors I know of that started in government service (military primarily) got out as soon as their mandated time was up.
I believe we have a moral imperative to offer necessary medical care to those who cannot afford it. I do not believe we have a moral imperative to offer an insurance card to everyone, however. Yes, we do need to improve our system, especially for those uninsured, but we should focus on the biggest problem first, which is not access to health care.
I think the only way we will see prices going down is if health insurance is treated like other insurance. If the average person paid his day to day care and held insurance for catastrophic illness (meaning making it more like car insurance or home owners insurance), we would see some changes in pricing. If this was further bolstered by transparencies in fees, fostering competition, we would see a radical shift in the cost of health care. If further bolstered by tort reform and information technology, we would wipe even more expense out. We would then be in a better position to try options other than insurance as the only solution.
During this health care debate, I have often heard people say “you of all people should understand the need for health insurance for all Americans”. They are talking about my daughter’s fight with cancer.
What I have found is this:
- Health insurance is an industry that does not really care about the cost of health care. They care about making sure they can maintain a certain percentage of profit despite the cost of health care. Thus, they set up rules that are easy to forget, that exclude certain items. They find ways to get rid of the most expensive options. And, they fight any more expensive option unless there is adequate medical reason.
- Those without health insurance get the same care as those with when it comes to terminal illness.
- Most of the cost of health care is written off for those who cannot afford it. In fact, I know many parents who had no insurance who pay less than I do for health care … and I am insured.
Imperfect system? Certainly. But despite having insurance, I don’t see insurance as the answer. In fact, if I had the option when I signed up for my current policy, I would have preferred an HSA with insurance for catastrophic medical only. It would have cost me a bit more out of pocket on a normal year, but the savings in premiums would more than make up for it. Through my daughters bout with cancer, it might have been more expensive, but not nearly as expensive as it would be if HR 3200 had passed back then and we had to go on that option.
I am not stating that all arguments for health care reform are bogus. There are many good arguments out there. I just don’t see “everyone having an insurance card” as an option that solves the real problems with health care in America.
To those who state “you of all people should understand the need for health insurance for all Americans”, perhaps you should be thinking “you of all people understand the problems with health care, so perhaps I should listen to you”. It is just as logically unsound as an argument, but it balances out the equation.
Peace and Grace,