The Health Care debate can probably be distilled down to a few words: costs, coverage, fraud, access, exclusions and rationing. There you have it. The whole debate in a nutshell. Let’s look at the individual words.
Rights – the Constitution has no provision for medical health coverage. It is not enumerated as a right and requires considerable extrapolation to infer heath care as a right.
The argument for coverage is that people don’t choose to have diseases and that having a disease is part of the human condition and, therefore, deserves coverage.
It’s a philosophical tossup, but it probably defines what your point of view is. If you think healthcare is a right, you probably favor the public option. If you think healthcare is an entitlement, you probably favor keeping and improving the current system.
Both sides agree that the system needs improvement, now.
Costs – it is obvious to anyone that cost for medical services is spiraling up every year. A major contributor of the increasing costs is the premium associated with malpractice insurance. Further, it is often said that Americans spend more for health care than people from any other county. What is often missed is that Americans have more health services provided and, accordingly, pay more. It is also true that we spend about the same as other countries when it is measured by percentage.
It goes without saying that anything that reduces unnecessary costs is a welcome change. While there may be differences of opinion about what to change or how to change it, there is universal agreement that cost should be contained or reduced.
We already pay for uninsured citizens and non-citizens to get medical attention. The Emergency Medical Treatment and Active Labor Act (42 U.S.C. § 1395dd, EMTALA) is a United States Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act and ensures transportation by ambulance companies and treatment by hospitals to anyone regardless of citizenship or ability to pay.
Public – most people do not want public or universal heath care. The resistance to government run health care programs is centered on issues like liberty, rationing, efficiency. Mandated health care takes away the freedom to choose for the individual. Most people believe that the government has never demonstrated an ability to run anything efficiently and would be vulnerable to continued rising costs and consequent rationing of services.
Private – a private, market-based solution this is still favored by many because many feel that the only way to contain costs is to expose it to open competition. Proponents of universal coverage rail against insurance company profits and executive pay and prefer a governmental solution
Regulation – most people do not want over regulation of the medical (or any) industry. At the same time, many of the problems that exist in the heath care business could be solved by enforcing existing regulation. Supporters for reform would endorse the current (1,000 pages, more or less) proposed legislation as necessary additional regulation to improve the system.
Fraud – there is universal agreement that fraud should not be a part of the system. Only a criminal mind would condone fraudulent activity. The cost for fraud is enormous and solving it would significantly lower the cost for health care. While there is enforcement action in place, the correction or elimination of fraud is often overlooked as a worthwhile solution for the cost issue.
Coverage – arguments for a public option say that a new program would widen the coverage to include “everybody”. In actual fact, there will always be somebody who is missed. Arguments against a public option point out that, while this sound altruistic, cost can be reduced only by rationing health care and that older people might be denied coverage.
There is also considerable spoken misinformation about who is covered and who is not. One popular viewpoint says there are 46 million people with no health coverage. We know that 9 plus million are illegal aliens and not eligible for coverage. Another large percentage includes people who choose not to have coverage, either by self-assessment of need or financial consideration. Some people with money chose to self insure and some people without money can’t afford health insurance.
There are currently 170 million people that are covered by employer coverage. It is estimated that 120 million would be forced to transfer to public heath insurance leaving the private insurance industry to collapse on itself.
Caps – one method of reducing or containing cost is to cap or limit what coverage for which a person is eligible. A cap can be a limit on the dollar amount of coverage of a limit on the types of coverage.
Exclusions – is another way of saying Caps. It also includes exclusions for pre-existing conditions. Insurance companies are reluctant to take somebody with a pre-existing condition because they will probably pay more as supported by statistics. It is more profitable to insure someone who is healthy and young.
Philosophically, most people against exclusions and have sympathy for people who have pre-existing condition.
It seems this could be handled via regulation enforcement or change.
Liberty – while it is considered to be an academic issue for some people, it should be remarked that many of the issues contemplated by the Founding Fathers, Continental Congress and the Constitutional Convention were decided in favor of liberty over perceived and sometimes potentially substantial advantages and benefits.
Those opposed to a public option say that the reduction in choice represents a reduction of Liberty.
Proponents of government run health care say that heath care is a right and the is no lessening of Liberty by delivering what people are entitled to receive.
Security – part of the cost reduction plan for health care is to take the system “paperless”. By computerizing health records, doctors and practitioners will have fast and accurate access to an individual’s health records. Part of the logic is that tests will not be duplicated because electronics test results for previous tests will be easy to see online.
Opponents of public run programs say that this will give the government unprecedented access to our detailed private information. Further, they are skeptical of the government’s ability to protect this information form hackers. Witness the number of times hackers have stolen information or identities from secure digital storage systems.
Abortions – most people believe that liberals will try to include coverage for abortions in public option health care programs. It is currently illegal to use public tax money to fund abortions.
Profits – proponents of public run programs say that insurance companies make too much profit and that executives are paid excessive amounts. While the executive pay issue is subject to stockholder review, insurance companies reported approximately 3% in profits for recent years. During the same time period, these same companies paid about 6% in taxes. That doesn’t seem excessive.
What people often forget is that a free market (and excessive profits) will encourage competitors who will offer a lower price when someone inflates their prices for goods and services. It’s only natural.
Rationing– as discussed above, notwithstanding other ways to reduced rising healthcare costs, rationing is the obvious way to offer services to more people while spending less.
Compensation – free markets level themselves. Unless a monopoly exists, an individual or company who has an excessive profit is picked off by competitors who will “work for less”. It has always been that way.
Proponents of public run programs are in favor of regulating compensation to doctors, executives and practitioners.
Inflation– health care cost are rising for a variety of reasons. One is inflation which is best controlled with good fiscal and monetary policy. The government can contribute by keeping borrowing to a minimum.
Malpractice – many people believe that victims of real malpractice should be compensated in legitimate cases of malpractice. It is complicated by frivolous lawsuits for malpractice and the resulting sky-high insurance costs to doctors.
Some states have addressed the subject by limiting or capping legal judgments for malpractice. California has a cap on $325,000, for example. Some countries have handled the problem by having laws that say you pay if you lose. The threat of having to pay legal fess for both sides limit the risk someone is willing to take when filing a lawsuit.
Torts – directly related to malpractice is the subject of tort reform. Trial lawyers support leaving the system the way it is allowing individuals to bring suit against individuals and companies without restriction.
Opponents say that court awards and penalties should be limited. An example would be medical doctors who pay approximately $170,000 in malpractice insurance premiums a year. This drives up the cost of services to the user.
Disability – disabled people should not be excluded from coverage and some proponents of social support say that people with disabilities should be given financial support commensurate with their inability to earn a living income for themselves.
There is a system in place to cover disabled people through the Social Security process. This system is vulnerable to fraud.
Medicare – most people with Medicare are satisfied with their coverage and services. From the fiscal point of view, Medicare is an abysmal failure racking up billions of dollars in operating losses every year.
An overlooked solution would be to use the Medicaid model to cover currently uninsured people.
Drugs – another philosophical disagreement revolves around drugs. Certainly there have been some miraculous discoveries and real advances regarding medicines. It has also been often remarked that the medical field is quick to prescribe drugs for everything form depression to a hangnail. Said another way, doctors are over-using drugs as a first line of treatment for almost everything.
Pharmaceutical companies are contributors to political campaigns and have influence with the Administration and Congress sometimes using lobbyists.
Pools– some states and companies have risk pools where insured can be “pooled” to spread the risks lowering the cost of healthcare costs. Regulations prevent this form being used more as a solution to the high cost of healthcare.
Children – uninsured children have been provided for through the SCHIP (State Children’s Health Insurance Program) program which covers children of lower income families
Indians – IHS (Indian Health Service) was established in 1954 to take over health care of American Indian and Alaska Natives from the Bureau of Indian Affairs.
It has had mixed reports for the service it provides.
Military – the military provides health care to active and retired members and their family. Current plans rumor that health care for non-active military will be eliminated.
FEHBP – Federal Employee Health Benefits Plan is health care for government employees. This is the program that covers the members of congress. Which has been described a the “gold plan”
Portability – Heath care coverage is not very portable. Insurance regulations exist at the state level and insurance is generally not portable form one state to another.
Proponents of state-run heath care say that a government program would solve the portability problem.
Both sides probably agree more than they disagree about portability. It makes (common) sense that people should be able to take their health care with them when they change jobs or relocate.
COBRA – related to portability, the COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) program provides extended (18 month) health care coverage to people who lost their jobs. The main problem with COBRA is its prohibitive cost.
Deficit – the main barrier to providing unlimited coverage to all Americans is the cost. Together with other government spending, there is no way to fund universal health care without deficit spending. In other words, we would have to borrow the money.
Proponents of public programs say that offering universal health care will create efficiencies that will pay for the system. People will practice preventative health care and treat problems before they become expensive problems.
Opponents of the reform program say that deficit spending takes resources from other programs and causes increased debt service expenses and inflation.
Bankruptcy – it has recently surfaced that the majority of bankruptcies have large medical bills as an underlying cause.
There is probably some shared opinion that no one should have to declare bankruptcy because of medical bills. A change in the bankruptcy laws would be a solution.
Dental – most health insurance in the US is a part of an employer provided health insurance program. Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts. This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. Sixty organizations were offering accident insurance in the US by 1866, but the industry consolidated rapidly soon thereafter. While there were earlier experiments, the origins of sickness coverage in the US effectively date from 1890. The first employer-sponsored group disability policy was issued in 1911. As compensation packages become more competitive, coverage has expanded and dental has become a standard benefit. People decide on a position with a company based on salary and benefits. Most competitive compensation plans include dental and Vision.
HAS– health savings accounts are another pre-tax way to pay for health care. Neither fish nor foul, HSAs will probably go away with public health care.
Emergency – as we covered earlier, The Emergency Medical Treatment and Active Labor Act makes ambulance and emergency medical service available to everyone regardless of citizenship or ability to pay.
Proponents of public health care point out that we already pay for uninsured people who use the emergency provision as a loophole to get medical service.
Opponents say that is true, so there is no savings for giving them what they already get.
ADD – accidental death and dismemberment is like dental and vision. Most companies offer it as part of their compensation plan or offer it as supplemental insurance at attractive group prices.
Uninsured – the number of actual uninsured has been a controversial subject. Easy to find information shows that 46 million people are uninsured in the US. Approximately 9 million of that number are undocumented immigrants (not eligible) and a significant portion is made up of young people who do not want any health insurance or wealthy people who pay for their own medical service and don’t want insurance.
There is probably no objection on either side to having everyone covered in some sort of basic program. It would seem inhumane in these abundant modern times to withhold medical services from anyone.
Research – functions best in a profit driven environment. Proponents of public health say that efficiencies gained in administration will leave more time for research.
Opponents point out that advances in technology have never flourished in a government controlled environment and are almost the exclusive province of profit operations.
Euthanasia – no one admits to supporting euthanasia, but the current proposals for health care reform include provisions for end-of-life counseling and financial analysis suggest that rationing cannot be avoided. Rationing implicitly implies euthanasia.
Incentives– profit, salary and financial support are different forms of incentives. Most government programs do not offer incentive plans and most government workers are examples of preserving the status quo (apologies to government employees with a work ethic).
Retirement – high medical cost is preventing people from retiring with a living wage. Some retirees are forced to choose between health care and food.
Mental – treatment for mental health has crept its way into our medical care system. With pet maladies like depression, ADHD and post __________ stress syndrome (insert your favorite item), mental health has created a multi-billion dollar industry based on iatrogenic (doctor caused) actions. Further, the most common solution in mental health care is to prescribe questionable drugs.
Many believe that mental health should not be covered in medical care plans.
Quality – it is assumed that the once uninsured person who now has health care has improved his position and the quality of his/her health care. Making health care available to more people improves the overall quality of the system.
Opponents point out that doctors and practitioners who are motivated by profits or returns on investments are likely to give better service and be interested is patient satisfaction. Doctors and practitioners who work for scheduled plan (predetermined price for a specified service) tend to have a “hands off” attitude about their patients.
Access – there is little disagreement that people should have access to the system. We are too advanced in technology and humanitarian condition to think otherwise. No one should suffer from lack of medical attention.
Doctors – there is a need for a continuing supply of doctors. The investment of time, effort and money means that fewer students will make the commitment to become doctors if the rewards are limited.
In a free market system, monetary rewards mean more people will pursue a career if the payback is good. Certainly people have motivations above money and a desire to help people will always win the day.
Nurses – whatever we say about doctors probably applies to nurses, health workers and practitioners.
Hospitals – the financial dynamics of hospitals could change dramatically. An automated and computerized system may simplify running a hospital. Proponents of a public system consider that hospitals make excessive profits and should operate according to scheduled (fixed by the government) prices.
Supporters of the current system would argue for better efficiencies leading to cost reductions, but say that the profit motive ensures competitive service and prices.
Socialism – similar to the issues concerning Liberty, people do not want Socialism which can manifest itself through 100% government regulated health care.
Politics – the issue of health care is an inseparable part of politics. Often a person’s opinions about health care are led by their political party’s position on health care.
Health care may be used as a Trojan horse to get other issues in the door or to achieve other political objectives.
Employers – are faced with a number of issues. Health care costs have been rising contributing to the increasing costs to businesses which is passed on to customers or taken out of profits.
Employers also use health care benefits as part of their compensation package which they formulate and use to attract talent. If businesses are relieved of the cost for health care, they lose control over wellness programs and lose a tool for attracting talent. On the positive side, it will eliminate expense, but may increase taxes.
Economy – one sixth of our economy is based on the health care industry as it is situated today. Changes in the economy are hard to predict. Medicare was passed in 1965 and was estimated to cost 9 billion at the time it was passed. Costs today are 30 or 40 times that.
The current proposal is estimated to cost $1.3 trillion. Actual cost could be more.
Insurance – will have to compete with the government.
Those who believe in public health care say that insurance companies will become more competitive with government competition.
Proponents of keeping the current system believe that the government, which is not required to make a profit,can have artificially low prices and will drive private insurance companies out of business. At that point, there will be a single-payer system.
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Most of the deficiencies in our current health care system could be corrected by enforcing current regulations or passing new regulations targeted to specific areas.
The main problems seem to be summarized by coverage, cost, fraud, access, exclusions, caps and rationing. It doesn’t make sense to restructure the whole system in order to provide solutions that are easily addressed with less severe invasive actions. We could consider the following suggestions:
- Maybe we could include people with preexisting conditions by changing regulations.
- Maybe we could remove the barriers between states allowing portability.
- Maybe we could change COBRA to allow continued coverage at an affordable rate for people who have lost their jobs or people who are relocating.
- Maybe the government could provide or subsidize malpractice insurance for doctors if they lower their price accordingly.
- Maybe we could give a federal tax credit toward health insurance premiums so that everybody could afford health insurance.
- Maybe we could be more aggressive in going after fraud and put heads on a pike when we find it.
- We could extend Medicaid to those who are uninsured so that no citizen goes without coverage.
There is no lack of good ideas from the left, center or right. One only has to look and listen.
The intent here is to enumerate and highlight the key issues and suggest some out-of-the-box thinking with regard to changing our health care system. Yes, we spend more per capita than other countries, but we have the best health care system in the world and we should not be impetuous or hasty about implementing sweeping changes overnight.
In the Fifties, Madison Avenue had a phrase they used to extend the life of many products. New and Improved was used for almost everything. Any minor change in the ingredients or packaging earned the right to call it New and Improved. As the consuming public became more aware and more questioning, it started to challenge some of these claims only to find that the label New and Improved was not always deserved. 
In a society where the government controls everything (a dictatorship, for example), it really doesn’t matter if the press is free. As a practical matter, the press is probably totally controlled in a dictatorship.
The discussion regarding the existence of something spiritual and causative can get deep and overly significant.
Part of the success of the American Revolution was that, after the Revolution, people had confidence that it was safe to trade with or invest in the United States. Consequently, trade with the US grew form year to year and allowed America to grow into a major economic force.
One of the most successful ways of getting people to believe a false statement is to mix in a half truth.