With the recent presidential debates and the debut of Michael Moore’s newest film “Sicko”, it seems that the issue of healthcare is of serious concern. Especially when one considers the recent statistics of 43.6 Americans are without health insurance, it can be argued that these concerns are not without merit.
Or are they?
While it can be viewed as tragic, the repercussions of such concerns infecting our political scheme give me more than just a case of the chills. Advocates of a single-payer socialized health-care program infect both Democrats and (arguably) some Republicans (I know that Mitt Romney does not directly endorse a tax-paid socialized system, his efforts to extend and basically require health insurance to all will require more government involvement in this issue than a true conservative, or economically savvy American should be comfortable with, even considering him throwing around words like “market” and “tax-free”.) Also, considering that Health-Care is the leading domestic issue of polled Americans, it is worth taking a closer look.
With such a large and encompassing (and admittedly emotional) issue, it is difficult to cover all views and aspects. I would like to focus on a few key issues and misconceptions, which I hope the readers here will research, discuss and elaborate accordingly.
Most advocates endorse a single-payer plan, as seen in Canada, and most European nations. While not entirely the same, the ideas behind such universal systems all operate under the same principle; providing guaranteed healthcare to ALL citizens, provided courtesy of their respective reigning government. Since 1987, the Physicians for a National Health Program (or PNHP for short) have been advocating single-payer, universal healthcare for all US citizens. They have served as an example for many advocates of universal care (including lobby groups and presidential/congressional hopefuls), so it is reasonable to use their stance as a starting point, since many of the issues and concerns being presented by today’s politicians are reflected by PNHP.
(For reference, I will be using the FAQ section on the PNHP website as jumping off points)
Single-payer is defined as:
…national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.
In other words, they claim that while it is “publicly financed”, it is still essential “private”. This will be the first item of discussion.
”Universal care is not socialized, but publicly funded private care”
To anyone beyond a 3rd grade reading comprehension and economic understanding, this will read as a large misnomer. Their claim, is that since the government only pays for the care, but does not give the care, it is still private. According to their website:
Socialized medicine is a system in which doctors and hospitals work for the government and draw salaries from the government. Doctors in the Veterans Administration and the Armed Services are paid this way. Examples also exist in Great Britain and Spain. But in most European countries, Canada, Australia and Japan they have socialized financing, or socialized health insurance, not socialized medicine. The government pays for care that is delivered in the private (mostly not-for-profit) sector. This is similar to how Medicare works in this country. Doctors are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage their medical practices or hospitals.
If a physician belongs to a large HMO group, do they not work for the HMO? Is their care-giving not controlled directly by who foots the bill? Under our current system, insurance companies can decide whether certain procedures/care/drugs will be paid. Therefore, the control of healthcare is directly under the supervision of the paying body, namely the HMO. Transferring such power the US government does not change this basic fact.
”Medicare/Medicaid is more efficient than private insurance”
According to the website:
The United States has the most bureaucratic health care system in the world. Over 24% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, and other non-clinical costs. Because the U.S. does not have a system that serves everyone and instead has over 1,500 different insurance plans, each with their own marketing, paperwork, enrollment, premiums, rules, and regulations, our insurance system is both extremely complex and fragmented. The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO.
Yet, a few lines down:
Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. One need only look at the example of the nation’s health insurance program for the poor, versus the National Naval Medical Center in Bethesda, MD, that serves members of Congress. Access to care for the poor is deteriorating because Medicaid is a grossly underfunded health care program. Because it doesn’t serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. D.C. General Hospital in D.C., which serves the poor, is always on the brink of bankruptcy. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered to be politically important. On the other hand, members of Congress have completely free access to care at National Naval, where the quality of care couldn’t be better.
While efficient, why is it that more and more physicians are jumping the Medicare ship? The problem? Reimbursement. Medicare underpays physicians so much that care to these patients if often denied. According to Medicare payments, as discussed here,
When your doctor or supplier agrees to accept the charge approved by Medicare as total payment for services, this is called “accepting Medicare assignment.” Medicare pays your doctor or supplier 80 percent of the Medicare-approved charge, after subtracting any part of the $131 annual deductible you have not met. For covered services, the doctor or supplier can charge you only for the amount applied to the deductible and the remaining 20 percent of the approved charge.
In other words, it is Medicare that decides what it will cost, then pays 80% of it. Then, accordingly, depending on whether or not the physician is under and agreement clause with Medicare (a “take it or leave it and don’t ask questions” approach), the physician must accept what they are paid as full-payment, regardless of actual cost of the care.
This approach, of course, would make any system rather “efficient”, now wouldn’t it? Medicare takes in money (from taxes) to pay for services, but then does not fully pay for said services. They “spend” less than they take “in”, making them “efficient”. Yet, doesn’t that defeat the purpose? If this efficiency is so important, why is the hospital that serves the “poor” under the constant shadow of bankruptcy? Why does it provide reduced care? Of course, the argument is that Medicare is “underfunded”.
”Universal Care will cost less then our current system”
Anyone with a basic understanding of free-markets will laugh at such a claim. How does one expect a monopoly to actually cost less? Again, according to the website:
The U.S. Supreme Court recently established that rationing is fundamental to the way managed care conducts business. Rationing in U.S. health care is based on income: if you can afford care you get it, if you can’t, you don’t. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don’t have health insurance. That’s rationing. No other industrialized nation rations health care to the degree that the U.S. does.
If we are to provide the same healthcare to all, including the have AND the have-nots, how will this reduce costs? If healthcare costs are already high for those who CAN afford it, how much more will it cost if the service is provided for those that currently can’t pay for it? Of course, such a system is already in place.
In most Emergency Departments, care has to be given, regardless of payment. More often then not, this cost is never re-couped. Instead, the cost is then distributed throughout the hospital by increasing cost of procedures/care, billing extra to insurance companies who, in turn, increase premiums. Healthcare costs go up all around, in order to help cover the cost of those that can’t pay. Adopting this system under a universal banner, will do no more to decrease cost than lighting a $10 bill on fire is equivalent to spending it.
For the remainder of this discussion, let’s look at the purpose of insurance itself, and misnomers on the actual cost to have it.
Comedian Chris Rock on insurance:
They shouldn’t even call it insurance, they should call it incase s***. I give the company some money, incase s*** happened.
While crude, it is rather concise, isn’t it? Insurance is to “insure” that in case something happens, you are covered. It’s a gamble. You pay money every month, just in case.
Let’s use an example: car insurance. You pay, every month, so in case something happens to your car, you are covered. Now, you can not have insurance (assume here it’s not a requirement of law) and gamble that you won’t get in an accident. Or you can gamble that paying a monthly fee and never using it, is still cheaper than paying out-of-pocket directly for something that does or could happen. Yet, how is car insurance fair? If someone has a history of expensive accidents and speeding violations, is it fair to make the “safe” drivers pay more? Can’t car insurance companies force dangerous drivers to drive “safer”? Not directly. Instead, they charge them more, since at-risk drivers are higher at-risk for increasing costs.
Now imagine, for a moment, that car insurance also covered “preventative” and “maintenance” care on your vehicle. Let us say that every time you got your oil changed, your tires rotated, your brakes fixed, you billed your car insurance. How much higher would your insurance premiums increase? If all were required to pay for oil changes to those that “could not afford it”, how much higher then would premiums be? How much higher then would the cost of oil changes become?
With health insurance, this is no different. Health insurance itself is expensive, because such things as basic, preventative care, are billed to insurance. Considering that a majority of the top 10 killers of men are mostly preventable, it’s enough to make you wonder if we are indeed paying for “care”, or paying for other people’s personal choices. Would it be tolerated by those who pay car insurance if part of premiums paid for upholstery cleaning to those who smoke/eat/drink in their cars? Not without demands of increased rates or insurance denials. Yet, according to the PNHP website:
Experience rated insurance requires higher risk people to pay higher premiums. This approach says that people who have had cancer or other problems in the past, or who have chronic conditions like diabetes and hypertension, must pay more because they are at higher risk of getting cancer again or having a stroke or other health problem. Experience rating allows insurance companies to “cherry pick” the healthiest people and either refuse to insure the sickest or, what amounts to the same thing, charge prohibitively high rates. This approach makes no sense. The whole point of insurance is to spread the risk so that everyone is covered.
If one cannot distribute based on risk, how does this bring costs down? How is it therefore paid? If you cannot charge higher risk patrons MORE, then EVERYONE has to pay more to be “fair”, according to such a system as single-payer. This alone shows that costs will increase, just based on risk.
Of course, the biggest push for single-payer is the belief that since 43.6 million Americans HAVE no insurance, it is because they can’t afford health insurance. Is this true? Probably not as much as you think.
In order to justify universal coverage, it has to be shown that the issue is of so much public importance, that it will be a government mandated provision. Police to ensure safety, military to ensure protection, even roads to ensure travel. Yet, why is there not push for universal coverage of food? Shelter? Why are these basic “needs” not provided, courtesy of your tax dollars? Why can one not walk into a store, and take exactly the food that one needs to survive? Is food not of greater importance than roads and even police for daily survival? Is food not more important than even *gasp*health care? The fact remains that even those who push for single-payer healthcare, recognize the need for self-preservation. If one puts other things in front of food in importance, they are regarded as a fool. Yet, why the double standard when it comes to healthcare? If it is so important that it needs government intervention to provide it to all (over food!), then why is it often put last?
According to some statistics, 65 million Americans have basic cable, while 50.6 million Americans subscribe to premium channels.
, 248 million television sets in households in 2001, and an average of 2.4 television sets per home. Out of all households, over 70% have cable and/or satellite television. 62% of Americans have cell phones, of which 64% pay more than $50 per month. And, in case you are wondering about who most subscribers are, according to this article:
Seventy-five percent of Mission High students have cell phones, according to a recent survey conducted by Truitt, and many of those interviewed said they couldn’t live without them. But 75 percent of the school’s students are also so poor they qualify for free or reduced-price lunches.
These are just a few examples, illustrating the perception of cost. How much more would a family be able to afford healthcare, if they went without such things as televisions, cable, satellite, and $200/month cell phone bills? If healthcare is so important, why do such trivial items come first?
Perhaps it is not our system that needs reformation as much as the people that it covers.
great post! You made a solid argument against universal health care without even mentioning the long wait lists that countries like Canada and France have for serious surgeries. People wait 9 months for a surgery that should be done immediately.
“These are just a few examples, illustrating the perception of cost. How much more would a family be able to afford healthcare, if they went without such things as televisions, cable, satellite, and $200/month cell phone bills? If healthcare is so important, why do such trivial items come first?”
This is exactly the argument that Theodore Dalrymple uses in dispelling the myth of a “poor” underclass in the Western world. The “poor” are not financially impoverished, at least not in historical terms. Go into the squalor of any inner city ghetto, and you’ll find almost everyone with cable TV and cell phones (not to mention the abuse of alcohol and tobacco, which costs thousands of dollars each year to keep up), yet living on junk food and barely feeding themselves.
The most important question is: What is health insurance? Is it akin to auto insurance, where you pay money in case something catastrophic happens? Or is it a form of welfare where everybody pays and the system takes care of all our health expenses? If health care is a human right, a viewpoint which is increasingly prevalent, then it must be the latter. The fact that we still speak of insurance is an anachronism. Today’s debate is about wealth redistribution, using health care as a vehicle to take from the rich and give to the poor.
This is really excellent. The comparisons to food as a basic need, and car insurance/maintenance puts it in a very clear perspective.
Reducing out-of-pocket costs increases demand for medical care - more people go to the doctor more, for basic preventative care or more trivial health concerns (and NOT only “in case s**t happens”). At the same time, supply of medical services is reduced because medical personnel have to spend their time handling paperwork and complying with regulations. So the cost of medical care rises sharply.
Many people point to the dwindling supply and high costs as proof that we need universal health care, or that we’d be lost without Medicare and Medicaid. But the more the government involves itself with health care, the more the cost rises (because of attempts to recoup the costs of those who don’t pay, underpayments from Medicare, and simple supply and demand.)
It’s self-perpetuating because the more costs rise, the more people jump on the “free health insurance” gravy train, which makes costs rise exponentially. Normally responsible people now want to use it, because health costs have risen to where they KNOW the price is an unfair burden, so they have no reservations about taking full advantage of any freebies offered. Soon though, supply and quality just run out. There’s a rush to get while the getting’s good, and then, boom, there is no affordable health care available for ANYONE - except the wealthy elite (listen up, people who apparently hate wealthy elites.) The reason there is an outcry for universal health care is that health costs are now obviously unfair for EVERYONE, because all who pay are responsible for those that don’t - both in taxes AND in the disproportionate cost of their own medical care. It’s also self-perpetuating because most people seem to believe that the problems health care is riddled with are caused by greedy doctors, greedy insurance companies, greedy pharmaceutical companies, and greedy and restrictive HMOs - which makes them call for more government involvement - which is what started it in the first place.
“When Medicare was set up in 1965, the politicians projected its cost in 1990 to be $3 billion — which is equivalent to $12 billion when adjusted for inflation to 1990 dollars. The actual cost in 1990 was $98 billion — eight times as much.” — (Harry Browne, Why Government Doesn’t Work)
For people who are concerned about the poor, it’s very important to realize that even people who are covered by Medicare pay more than twice as much in out-of-pocket costs (after adjustment for inflation) than they did before Medicare existed. Prices rise to such an outrageous extent that the “help” provided by government is absolutely meaningless. It’s like being stabbed and then offered a Band-Aid.
A service provider answers to whoever is paying them, as you pointed out. With something like health care, it’s just dangerous to have your physician answering to someone other than you, the patient. Doctors should answer to patients.
Many people can’t give up on the idea of themselves as champions of the poor. That image of themselves becomes so important to them that it overshadows their concern about the actual well-being of the poor (and everyone else!).
People have the RIGHT to buy a big-screen TV or twenty cheeseburgers instead of health insurance, and they have the RIGHT to die because of that choice. But no one has the right to force me to protect others from the consequences of their choices - although I might be PERSUADED to do so - especially if it actually helped them out, and taught them to make better choices. But why would protection from consequences ever result in a lesson well-learned?
“Many people can’t give up on the idea of themselves as champions of the poor.”
I hadn’t thought about it that way. That explains a lot. That’s why arguments based on liberty and freedom won’t change their minds. It doesn’t matter that universal health care erodes personal liberty, because the champions of the poor are concerned only with reducing economic inequity.
And when those champions are politicians, the only tool they have is government. So they try to use government to solve the world’s problems.
plus, champions of the poor are primarily concerned with feeling good, not actually doing good. It feels quite good to think that by pushing for universal health care, you’re helping the poor. Is it doing good? Of course not.
This will probably not be a well-organized comment. Having stated that:
- It astounds me that the so many people seem to be caught up in the Universal Healthcare fanfare. Many of these people seem to confuse the word “Universal” with the word “free”. I think the average man-on-the-street who is in favor or Universal Healthcare would say it is a necessity because they cannot afford their own insurance or healthcare. I am not going to argue that case, as the author has already taken on that point. I am going to argue the simple math: Things That Cost Money = Money That Has To Be Collected/Paid. In all reality, Universal Healthcare would probably end up costing the uninsured more money than they pay now, simply due to the increase in the volume of people using said services. I have seen many coworkers/family members/friends go to the doctor for the most trivial things. Their reasoning is that they have health insurance and they pay for it, so they are going to use it. Imagine the drain on our healthcare system if every Tom, Dick, and Harry had the coverage to go to the hospital everytime they stubbed their toe?
- “On the other hand, members of Congress have completely free access to care at National Naval, where the quality of care couldn’t be better.” It is very hard for me to take an article (or website) seriously when it attempts to make an objective argument with a subjective observation. Do the doctors at National Naval give you hugs and kisses and make you hot chocolate? Well, then it COULD be better, couldn’t it? How silly.
- My car insurance argument and Chris Rock quote made it in there! This pleases me greatly.
In general, I have no idea how to fix the system. I do agree it is broken.
I specifically don’t like the fact that health insurance is often tied to employment and I suspect that is one reason a chunk of the 43.6 Americans you mention (oh, did you really mean 43.6 million ?
)don’t have insurance. It isn’t because they are so poor, it is because they’ve lost their job, or between jobs, or they’re self-employed or under-employed, etc.
Secondly, I’m not so sure we can compare car insurance to health insurance. Car insurance is mandatory, but only liability, for when you hurt someone else with your car. Comprehensive and collision insurance is not required, so I don’t think the two types of insurance are analogous. Further, we have the choice not to drive if we cannot afford car insurance, but we really don’t have the choice to not live if we don’t have health insurance.
“plus, champions of the poor are primarily concerned with feeling good, not actually doing good.”
It’s convenient to dismiss them as people who don’t really care, but that’s intellectually dishonest. We may think they are gravely mistaken, and that their proposed solutions will actually cause more harm than good, but that doesn’t make them wholly concerned with their image to the detriment of others. It’s more likely that they are genuinely trying to help the underprivileged. We can at least grant that they are sincere in their efforts, rather than painting them as self-absorbed monsters concerned only with their own feelings.
Jew, I am not sure how you got from my statement that I think that the “champions” don’t actually care. They do care, and not for their own “image” either. However, they don’t care that their ideas have been time and again proven wrong. They care that promoting these policies makes them feel good, not that they actually work. It’s an emotion-based worldview, rather than reason or fact-based one. I’m not painting them to be monsters by saying that, just pointing out an inherent weakness in their mentality.
For example, as I posted on my blog a couple weeks ago, these are some other “leftist” ideals that have at their core a “feel good” vs. “do good” philosophy:
- the death penalty (as John Lott’s new book, Freedomnomics, points out, studies have shown that each execution saves on average about 18 potential murder victims): it feels good to not execute people, so the left is against it.
- Welfare (Theodore Dalrymple is one of the best at dissecting the falsehoods rampant in the left’s support of welfare): don’t think I have to explain this one, seems like most readers on this site would probably agree.
- Ethanol (not nearly a right vs. left issue, as many people have fallen for this one, but it does have its roots in environmental extremism): turns out, ethanol creates more pollution than it eliminates. But it feels good to avoid using evil oil.
- Save Darfur and the ONE Campaign against Poverty (again, good ideas on the face of them that don’t fit neatly into left/right boxes, yet both movements are generally led by left-leaning people): Neither actually do anything. In the case of Darfur, all this hand-wringing and online petitioning hasn’t done a thing, when what we really needed was some carpet bombing. With the ONE campaign, millions of dollars have been sent to African countries only to be stolen and misused by the corrupt government. But it feels good (and takes little energy) to throw money at a problem.
- Anthropogenic Global Warming solutions (plenty of left and right people are concerned about this issue, but the hysteria began from the environMENTAL left): leaving aside the debate of if AGW actually exists, the solutions put forth thus far have run from silly (Sheryl Crow’s “One square of toilet paper per visit” idea) to absurd (Kyoto Protocol would lower the Earth’s temp by .1 degree in 50 years, but would completely decimate the developed world’s economies). But it feels good to think little ol’ me could do something to save the world from imploding, exploding, or melting.
“However, they don’t care that their ideas have been time and again proven wrong.”
OK, I see what you’re driving at. You’re not accusing them of intentionally making irresponsible decisions just to feel good. You’re saying that they experience the world emotionally. The poor need health care, so the emotional response is to give it to them. Right and wrong are based more on emotionally satisfying a person’s wants than on an unforgiving standard of individual property rights.
So the fact that universal health care erodes individual liberties is irrelevant, because rigid adherence to concepts of individual freedom is less important than empathy. The most important thing is that the government should offer help to those in need. In other words, security and safety from a cruel world is more important than the abstract concept called freedom.
In one sense, I can see the allure of that idea. After all, what good is an absolute right to life, liberty, and property if I’m dead. I’d trade a lot to extend my life. When I’m dead, what good is a government that protects my rights? Maybe I’d have been better off with one that protected my life.
Exactly, except when you start to think about it, those “feel-good” policies are actually bad for poor as much as they are bad for everyone else. Welfare, check. Death Penalty, check. Save Darfur/ONE campaigns, check. Global warming solutions, mega check (by destroying the developed world’s economies, the poor in Africa are much less likely to get help from us).
I’m reading Carl Bernstein’s book on Hillary Clinton, and it talks about her transition from conservative to liberal. It really is about heart and not reality. The phrase she used is “a mind conservative and a heart liberal.” I can’t relate to that. How can your heart believe something that the mind rejects?
For an answer to that question, ask any Unitarian Universalist; if ever there was a perfect example of the heart overruling the mind and reality…