A non-ranting opposition
I've seen lots of comments as to the mental stability of those who oppose health-care reform, so I'd like to throw out someone who has studied the issue, and remains opposed .I'm not opposed to reforming the system in concept, but I haven't seen a suggestion that contains realistic or implementable programs. This is why:
America is too big. There are more than 300 million people in the United States. If we do it on a state level, then we're leaving people at the mercy of the state governments, and you can ask Californians how well that's working for them. Or Floridians or Coloradans or any state that's caught in massive shortfalls when up against mandated budget locks. So it has to be national. But expanding any program to include everyone means an increase in bureaucracy that would have to at least eat up any real savings, if not more.
But the largeness of American causes other problems. Sarah Pain was over the edge with death panels but you do have to assume that there would have to be some rationing of services. I'm not as concerned with big ones as I am with the small ones. What are we going to cover and what are we not going to cover, and how are we going to decide? IVF? My sister-in-law just had a preventative double mastectomy (there is cancer in her family history, but not in her at the moment)--would we want her reconstructive surgery covered - do we all want to pay for that? What about therapy? What about Xanax or sleeping pills? If we're all paying for it, shouldn't we all have a say in how the money is spent? Do we want to have tax dollars spent on Terry Shavios when it could go to vaccinations? Are we going to start having referendums on what procedures are allowed? If we're saying healthcare is an inalienable right, then shouldn't everyone have access to the most advanced treatments possible, regardless of cost? My father had an experimental radiation treatment for his cancer - it didn't buy him a day, but it bought him hope. In a system supported by the government, shouldn't that be available to everyone? All government programs involve prioritizing. With a free market, there are choices between providers, between programs.
And along the lines of cost, how do we pay for it? We've heard the commentary about every industrialized nation having government healthcare, but we leave out that every other industrialized nation has a higher tax rate than we do. Maybe you think we pay too little in taxes, but if you do, you're in the minority. Even Canada has a tax rate about 6% higher and a 5% national sales tax (that's why the Blue Jays and Raptors have such ah hard time keeping players). Everyone pays more. But we don't hear that argument about healthcare in the US. We hear about the rich paying more. I find that idea distasteful - if this is a national priority, then it ought to be paid for by everyone. Make the tax hikes progressive if you want to, but make them universal. If we all benefit, we all pay.
And that is the heart of the problem. There may be 40 million people without insurance, but that means there are 270 million who have it. Everyone may bitch about their insurance, but they also bitch about their gas bill and the cost of bread. There is not a national mandate for this, beyond everyone wanting their own bills to be cheaper. And for every horror story out there, there are some good ones as well. Of course, I'm biased. I have twin boys who were born 10 weeks early. They were in the NICU for six weeks. The bill was $250,000. You know what I paid? $200. My wife gets a monthly shot of Lupron to help ease some of the pain of her endometriosis. The shot cost $500. It cost me 10 bucks. When my dad was dying insurance paid for in-home care, a private nurse, hell, even one of those chair-lift things so he could get to his own room. He got hurt in the Bahamas (where there is national health care) and the bill was $16,000.
Healthcare reform may be necessary. But until we're willing to ask all the questions about it - until we're willing to address all the concerns and all the consequences, forseen and otherwise, we need to hold off. Tweak what we have, but keep the fundamental system in place.
"Everyone may bitch about their insurance, but they also bitch about their gas bill and the cost of bread."
Wow. False equivalence much?
August 14, 2009 2:31 AM | Reply | Permalink
The point was that people alway want things to be cheaper and better. Healthcare is no different. When you cite polls about the majority being unsatisfied with their insurance, that's where the number comes from, not from overall dissatisfaction with the system.
August 14, 2009 8:44 AM | Reply | Permalink
I wanted to think about this before I responded. First, I love happy stories. Your twins are healthy and your wife must have had a time of it, especially for those two weeks. wow
I also thought it will be fun over the years as they grow and try to figure out why one of them is ten days older. hahahahaha
I am happy you had full coverage. And I do not know your finances but it sounds like if there had been a five thousand deductable you would have been elated.
Now the second point is that there are PAID thugs, really, going to rallys with printed programs telling them how to disrupt any cogent discussion of this matter in public.
There are also within those group of thugs, armed thugs who are nuts, who drop guns, conceal guns and scream second amendment rights.
There are groups calling for the violent overthrow of the United States Government. We must be vigilant.
Third, 47 million people cannot be discarded. Infections develop, disease develops, plagues develop. That is why access to physicians is of the utmost importance to us as a nation.
Fourth, the glass is not 80% full, not by a long shot. There are not 250 million Americans who have anything approximating the coverage you have.
I would doubt fifty million do.
THE END
August 14, 2009 3:09 AM | Reply | Permalink
I'm not as concerned with the gun-toting, overthrow the government folks as you are. i believe that in the end, people act in their own self interest most of the time, and even the crazies will pause before rioting in the streets. That said, if they care enough to riot, there must be something that inflames their passions to that level.
There are some that are disingenuous, but my guess is most are not. They are people are are scared of losing that they have. They are scared of the coverage they have, slight or not, expensive or not, will be taken away and given to someone else. That's the fear, and it's a strong one. Remember, most of the older generation that is protesting was taught communism, or socialism, was evil. Not wrong, but evil. They lived in fear of that very system one day deciding to either blow them off the face of the earth or invading to enforce it. So those fears, while unsubstatiated, are embedded deep. So anything that resembles what their mortal enemy proselytizes was antithetical to everything America was about. (in my school, it was called Americanism versus Communism, and was required by law). So expecting them to embrace any plan that begins to reek -- or that can be successfully labeled communistic -- is unrealistic.
I agree that we can't sacrifice 47 million people. but what sacrifices are we willing to pay to help them? I'm a Realtor. I pay $1165 a month for my health insurance. But a lot of Realtors -- some who are making good money -- decide to go without. They can, in all likelihood, afford; they choose not to spend. Are we going to make them?
August 14, 2009 1:12 PM | Reply | Permalink
I recommended this post, although I disagree deeply with your basic premise. This is exactly the kind of discussion we SHOULD be having. It makes my head hurt to listen to these 'town meetings' - not as a supporter of Health Care reform, but as as American and as a thinking human being. We simply HAVE to do better than that in 2009 to cope with the many complex and novel problems this new century is sure to bring.
MY basic premise is that Health Care is both a public right, and a public obligation: It's really that simple for me, and I'm sure that colors everything I think about how it should be done. ASIDE from that, I personally think we are heading for some real practical problems if we continue to do business in the same way we have been.
To provide a counter-point, in rough order:
(1)We always have had and always will have a 'bureaucracy' when any subject as vast as Health Care (currently almost 17% of GDP) is involved. The question is, are we willing to trade a private, profit-making bureaucracy for a public one? 'Rationing' falls under precisely the same umbrella, and raises precisely the same question.
(2)I personally agree with you about taxes, and the nature of the tax obligation: I say we should ALL be willing to contribute a fair share. At the same time, we should all realize that higher tax payments will result in LOWER private payments for insurance, co-pays, and uncovered expenses. It is to be at least plausibly HOPED that removing the profit requirement from the financing side will result in lower overall costs.
(3)The 'unisured' problem (whatever its size) is one we ALREADY pay for. It is largely a semantic issue, in the sense that it is already included (and inefficiently, at that) in the +2 trillion $$ spent for Health Care in the USA today.
(4)Let's take at face-value the assumption that a large majority have good private Health Insurance, and like it. That may be essentially true, but it misses the point. Let me make what I see as the 'point' metaphorically:
If I'm floating down the river with my buddies, drinking beer and catching fish, I'm naturally having fun. But how much fun I'm properly entitled to have in that situation has a lot to do with what is going to happen AHEAD of us. If there's a waterfall a mile downstream, I SHOULD be taking account of that potential danger, and be willing to stop enjoying myself long enough to do something about the waterfall. If I don't care, or perhaps don't even KNOW about it, or don't even believe it's there after being warned, it's all going to come out in the same disasterous way if it IS there, and me and my buddies go over it.
August 14, 2009 9:11 AM | Reply | Permalink
Thanks for writing and your contribution to the debate.
I'm going to address 1 and 2 together, because my response will be the same, and it has to come in a question -- why do you think costs are going to go down with single payer. Even the CBO says that's not the case. The only thing that can reduce the overall cost is to reduce services -- you may find some savings in waste or duplication, but not enough to matter significantly. You want to take profit out -- but you aren't saying profit for healthcare is 6 percent of the GNP, are you? So where does the rest of the savings come from? Doctors still get paid. Nurses still get paid. Orderlies, technicians, clerks still get paid. Equipment still has to be bought. Electricity still has to be used. If, as a nation, we are going to lock those prices, we're going to have to lock those salaries as well. And the prices for equipment, medicine, whatever. If we don't lock them, we're still going to see escalation.
You are right that by raising taxes for this program in exchange for lowering insurance payments makes sense. But it won't be seen that way. Taxes will get cut again, and then what?
I like your floating down the river analogy, but that's mostly because it's been a long time since I've taken a float trip. using it, what do you suggest -- that someone put signs up warning of the falls? How about a big net to prevent anyone from going past it? How big a net? There will always be those who choose to fish beyond the safety area, insured or not.
This is what I think. If you offered comprehensive insurance for $200 a month, there would still be 15 million or so who wouldn't want to pay it. Some still wouldn't be able to afford it; some just want to go past the net.
August 14, 2009 1:49 PM | Reply | Permalink
msa3,
To carry the waterfall motif to its logical conclusion, much depends upon who we identify as being in the boat. You seem to suggest that some are in it, while the majority are safe on the bank. Like most advocates of reform, I suggest we are ALL in the boat, whether we want to be or not, and whether we are currently OK with our insurance or not.
As to the specifics of the 'costs' question,that basically IS the waterfall. We are currently at nearly 17% GDP, and most experts say we are beginning NOW to approach the warning zone, with no apparent effort to slow ourselves down. Somewhere around 20%, we'll inevitably crash into the rocks below (ie, ALL of us). We can argue over HOW to lower costs, but the fact remains (it seems to me) that one way or the other, we MUST either get that done, or risk economic disaster.
August 15, 2009 9:17 AM | Reply | Permalink
Matt, I don't have time to comment as much as I would like to on your thoughtful post, but just wanted to note that the CBO is notorious for underestimating long term savings from programs while overestimating costs. Here's an article by former head of US Health Care Financing Admin (Medicare/Medicaid), Bruce Vladek that expounds on this point.
August 15, 2009 10:51 AM | Reply | Permalink
What your thoughtful post does not discuss is cost. I have no idea what your economic situation is or if you pay for your own insurance or have through your employer. However please explain to me how as a nation we sustain healthcare eating up 17% of our GDP. How do we compete against countries where it half as much?
Can you as an individual sustain having your premiums going up every year from an average of 11K now to over 22k in the next decade?
Rationing, there already is rationing by the private insurers. They deny care everyday.
Next, as to the bahamas experience of course it cost $16K. You had not paid into the system, you were not a citizen and therefore not covered.
August 14, 2009 9:34 AM | Reply | Permalink
I want to say I want to respond to everyone, but the aforementioned twins are my watch this morning, so I will respond later this afternoon. Thanks for writing.
August 14, 2009 9:55 AM | Reply | Permalink
Hey there,
Simple question. If you didn't have your excellent insurance coverage - or able to afford any healthcare coverage - would your stance be the same?
I too rec. this post for the content, not because I endorse the sentiments stated.
What I took from this was that you and yours have what you need and therefore all in your bubble are well taken care of, so the rest isn't your concern.
That truly saddens me. And, are you at least working towards 'tweaking' the current system to improve it for others who are so in need of the ability to obtain needed healthcare?
August 14, 2009 11:12 AM | Reply | Permalink
Hey Sam --
I'd like to see Medicare available to everyone who does not have employer-sponsored insurance. I would like to see COBRA benefits extended for as long as you can pay them, or until you have another insurance option. I'd like to see government sponsored urgent care clinics and I liked Ellen's idea a few weeks back of government sponsored health-care loans.
But mostly I'd like to see a debate about the entire big picture and the ramifications of a single-payer plan, rather than hand wringing.
And to answer your question, of course my position is dictated by my experiences. But I also made sure I had insurance before I started having kids. I took a job I hated last year to make sure I had insurance, and that bought me another 18 months of COBRA. And I've found a way to keep up with the payments. It's not easy, but it's the first check I write every month. I've got another insurer lined up when COBRA runs out. I don't love my plan, but the consequence of not having it is much worse.
August 14, 2009 2:13 PM | Reply | Permalink
I probably can't. But I also can't see how that matters. The money has to come from somewhere. Costs and salaries aren't constant. Why do you think the costs will be reduced for a government program if services aren't reduced as well? Where does the cost savings come from in a single payer system?
August 14, 2009 2:02 PM | Reply | Permalink
That was supposed to be in response to jsfox. Sorry for the discontinuity.
August 14, 2009 2:14 PM | Reply | Permalink
The questions that you ask are legitimate, specifically concerning cost and payment.
Simply because a problem is too big or too expensive is not a reason to delay action. This is precisely why the federal government must get involved. The problem is too large for any single state or entity to solve.
You say that there is no plan that is realistic but I say to you that the system in its present form is not sustainable. It works well for some such as yourself and not others. I agree on this point. But the fact remains that premiums continue to rise, the uninsured continue to rise, the costs continue to escalate. How long before it catches up to you? I don't know but the odds are not in most people's favor.
The so called bureaucracy you are concerned about already exist in the form of medicare and private insurance. Its a multitude of smaller bureaucracies with separate rules, motivations and results. Your end of the system seems to be working well but that does not apply to 270 million of us. I can attest to the number of phone calls I have to make to insurance companies on behalf of my patients just for the simplest matters.
I do not have the perfect solution. I suspect that everyone is going to have to pay in some form or the other. The only thing I am certain is that reform will happen, now while we have time to decide or later when we have no choice.
I find it ironic that most people would consider education a necessity for life but healthcare an abstraction that only happens to other people.
I appreciate your thoughtful posting.
August 14, 2009 8:28 PM | Reply | Permalink
America is too big is a specious argument. Switching to some form of single payer would be a simple and straightforward means of covering the entire population and yes, even our large population. Saying it can't be done because there are too many of us is simply not true. They said we couldn't go to the moon but we did. Providing health care for the people of the country is easily within our reach if we wish it to be so. We have the moey, the facilities and the expertise in every respect.
Increase in bureaucracy? Upon what evidence? And if you are correct so what? The insurance companies spend close to half of the money they extort from Americans on administration. Medicare spends a fraction of that percentage. Any expansion in bureacracy would be more than acceptable given the savings realized by dumping the insurance company parasites. Even if the bureaucracy is expanded we can do this. And the cost, well again, by moving to a single payer plan we can realize vast and immediate cost savings that would be used to pay for our now universal health program. There are numerous ways to approach this problem of cost, but it is silly to fret over what it costs given how we are losing our collective shirts under the system we now have. The idea that a for profit system might be more cost effective is a gut busting joke.
Rationing? Surely you jest? We have rationing now. It is simply determined by whether or not you have enough money or are lucky enough to have the right coverage. People are routinely being denied medical procedures because a bean counter employed by an insurance company knows they can only provide x amount of this procedure and that test and remain profitable. I'd much rather take my chances on how things will be rationed under a universal, government run, not for profit organization.
We could easily be discussing all these things in a rational and comprehensive manner except the Republican Party and it's allies who are sucking trillions out of the economy annually for their own enrichment under the current rotten setup aren't about to allow that to happen.
Fortunately, we can look around at every other industrialized country and see that healthcare in the US can obviously be provided to all citizens at a lower total cost than what we expend on healthcare for 2/3 of the population right now and with much better outcomes. Instead of having to go over and over this same territory for the next 50 years, we first have to simply decide it is time to act. That time has come.
August 15, 2009 1:51 AM | Reply | Permalink