The Thinker

Things I know about health care reform

I would hope most of these points on health care reform would be obvious, but based on the debate in Congress, apparently not.

  • Just as there is no free lunch now for health care, there will be none after we are done reforming health care. It is going to cost a ton of money no matter what happens or does not happen. In the end, doing nothing will be far more expensive than creating universal health care.
  • The first decade of universal health coverage is going to be particularly expensive. There is no way around it. This is because there are forty seven million uninsured Americans and their health is often poor. Treating their chronic problems is going to be very expensive. For many of us who are insured, our health is poor too. We eat too much, exercise too little, and have too many bad habits. Often, we also do not particularly like who we are and where we are in life. In short, we are a seriously messed up people, physically and psychologically. This is due in part to our pretension that we are all rugged individualists when in fact we are all intimately tied together in a mutual codependent relationship. What do you think all those roads, bridges, railroads, telephone lines and networks mean, anyhow?
  • The reason a public health care plan is being opposed has nothing to do with socialism, but profit. The American medical industry is hugely profitable and the powers that be want to keep it that way. In short, profits come before people and as a result, people are needlessly dying or living in unnecessary misery.
  • While there is much we can do to control health care costs, in the end costs will only level off if we get off our fat asses, lose weight, kick our bad habits, and live healthier lifestyles in general. In short, we have to grow up and face the music. We need a government that tells us this truth and provides incentives so we will choose to get there.
  • A public plan will deliver quality care for lower cost than private plans. America’s public plan may not turn out to be as well thought out as health care plans in places like Europe. By squeezing out the middleman, it will be more affordable than any plan private industry can put together. Moreover, private industry knows it, which is why they are fighting so hard against a public plan. It is their death knell. Just look at the administrative cost of Medicare, Medicaid and the Federal Employees Health Benefit Plan and compare these expenses with our private health insurance administrative expenses. The latter are many orders of magnitudes more expensive.
  • A public health plan would only be socialist if the government owned all the hospitals, doctors’ offices, labs and clinics in the country. That is on no one’s radar. However, a public health plan would require universal insurance coverage and set uniform standards for patient care. This is not socialism because the government does not own the means of production. It is no more socialism than the FAA is socialist because it directs the air traffic.
  • A workable American version of a universal health care plan would have three levels of service: basic, silver and gold with the level of care rising depending on your ability to pay. This is because, despite our pretensions, America is class conscious, so we will want a higher level of service based on our ability to pay. Those of us who can afford gold service will want to flaunt it.
  • We already are paying through the nose because we do not have national health insurance. The cost is manifested in our emergency rooms and added on to premiums paid by the insured. All things being equal, if the uninsured contribute to their health care, it drives down premiums for the rest of us.
  • President Obama is right in that we cannot move in a revolutionary way from our current system into a single payer system. A single payer system is a likely final destination. We can get there by letting private plans compete under standardized rules with a public option. A single payer system will emerge when it becomes clear that the private sector cannot be profitable while delivering the same level of care as the public plan. When this happens, no one will shed a tear except those currently reaping windfall profits.
  • Medicare and Medicaid already prove the government can run health care systems. They exist because the private insurance market did not want to serve these markets. Private industry does not want to offer affordable health plans to the uninsured or the uninsured would have them. What are we afraid of?
  • Despite the American Medical Association’s position, most doctors’ offices would be thrilled to accept a modest fee to do away with the nightmare of dealing with insurance companies. Their paperwork is costly, burdensome and adds no value to patient care.
  • Rugged individualism is a nice virtue but incompatible with 21st century medicine. When it comes to medical care, we all go down together or we all rise together. This will provide plenty of incentive to make a workable and universal system.
  • An effective compensation system will reward solutions rather than reimburse for tests.

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