Tuesday, February 27, 2007

Concessions


Sorry for not posting for so long. I guess I over-exerted myself with that big roast.

Since the weather here has become more spring-like I've been inspired to do some spring cleaning. Cleaning usually coincides with lots of thinking, and most of my recent mental energy has been spent on the health care issue. It's pretty clear that there are some serious problems with the health care system of the U.S. I can't say that I've discovered any solutions, but I have finally resolved my basic moral ambiguity about it. And that, I think, is probably the first step to solving any problem.

Since I am a big believer in and supporter of public education, it finally occurred to me that it would be isomorphic for me to see health care in the same light as education. Since I believe that all have a right to education, then why should I think differently about health care (which is probably an even more basic need than education)? Now, I'm not beginning some swing to the left here, but it does seem more consistent to treat the two in similar ways.

My primary reason for supporting public education, despite its problems, is because it is in the best interest of a society for its citizens to be educated, and it seems like a valid pursuit of the society as a whole to provide a basic education for all. Now if I just replace "education" with "health care" it seems to also apply. It is in the best interest of a society to assure that all citizens have access to basic health care.

Okay, so now I've found my moral "north" about it. The next step is to consider the "hows" of it.

Well, I still have lots of cleaning to do, so I must go get started.

17 comments:

dhammett said...

Not sure I agree, here, Rae Ann. I'm not crazy with what the government has done with public schooling. Way too much indoctrination and social engineering with way too little actual teaching.

When the same principles are applied to health care I see a prescription for disaster. People are disillusioned with HMOs. Imagine how much worse it would be if the government were running things. Actually, you don't even have to imagine. Just look at the VA. Their hospitals are reknowned for poor medical care. So much worse if you were to apply it to the general populace (unless you feel that bad health care is better than no health care). Plus, I'm not a big fan of government getting any bigger.

Additionally, are you setting up a caste system for the haves and the have-nots? For those who have the money or insurance for private health care, they can go to the doctors they chose, while the poor are stuck with government doctors? Or do all doctors have to work for the government? Then, they'd be paid middling salaries, because we all know working for the government won't make you rich. So where's the incentive for the best students to go through the rigors of medical school, residency, etc?

How would government health care be any better than the free clinics already available? Hospitals, by the way, are not allowed to decline treatment in an emergent situation because of the finances of the patient.

Sorry. I just don't see this working well.

Rae Ann said...

Hi dh,

All of those are valid questions and concerns, and maybe that's why my mind wandered off to the beach. ;-)

As it is now, the health care system is *already* a caste system as you described with the "haves" and "have nots." I didn't specifically say that the *government* would run the healthcare system. I also cringe at the idea of the government getting any bigger and more into my personal business.

I was just saying that it does seem like a morally correct stance that everyone should have access to the healthcare they need, just as everyone has access to education. As for how to implement it, that is what needs to be brainstormed for new and innovative ideas.

Basically, my point with this post is to show that as a society it really is our *moral* responsibility to make sure health care is as available as education. How to do it, I'm still not sure. But just because a problem is difficult isn't a good reason not to consider it.

As for public education, it was good enough for me, and so far it has been good enough for my kids. I'm not convinced that public education is as bad as many people like to think. If nothing else it's a starting point.

Incidentally, I've heard a little about Walmart setting up basic health clinics in some of their stores, for such things as checkups and minor illnesses. I think that's a great idea. If health care can become as easily and cheaply obtained from Walmart as toothpaste and detergent, then that capitalist solution will work out best.

It's a very complex issue that requires lots of consideration and not so much quick reactions.

dhammett said...

Don't know about Wal-Mart, but Walgreens has set up clinics. Of course, without the proper insurance, seeing a health care provider costs $75.

No offense about public education. But schools in our day and age (especially mine - don't rub it in) didn't engage in the brainwashing about rainforests, global warming, evolution (well, ok, maybe some evolution), diversity and alternative lifestyles, etc. that they do now. You know as well as I do that to raise your children with conservative values you have to fight an uphill battle daily.

I believe we each have in individual responsibility to make sure health care is available to us. I have two sons out on their own. Both have more than one part-time job, but neither has health care. It's something we discuss frequently. It's their responsibility, though, not mine. Except I accept it as my responsibility because I love them. But I'm not looking for the government to give them anything. They're able-bodied...they need to look after themselves.

I'm not denying it's a complex issue, but without a concrete plan you can't expect much more than quick reactions. And unless you can provide a plan for me to consider, I'll stick with the mantra of personal responsibility rather than heaping another government white elephant on the back of taxpayers.

Rae Ann said...

well, shit, my comment got lost. I'll try to muster up the energy to redo it.

Rae Ann said...

Redux:

Okay Mr. Instant Gratification ;-) if I had all the right answers instantly then I wouldn't be wasting my time with a blog. ;-)

Sure, personal responsibility is the thing for most people, but there are pleny who aren't able-bodied or otherwise capable of providing everything for themselves. And there are plenty, my family included, who would be financially devastated by a serious medical emergency. Health care should not cost as much as a home mortgage.

Walgreens isn't doing anyone any favors with $75 doctor visits. Seems like the Walmart deal was more like $30 with no insurance involved at all. Now, if some company (Walmart or whoever) can come in a do business without the insurance companies then I think that's step in the right direction.

The insurance industry is the biggest culprit here, and it wouldn't hurt me one bit to see them fall by the wayside in the same way that labor unions are beginning to do. They both have outlived their usefulness and make everything more expensive than it needs to be for everyone.

Let me say *again*, I'm not pushing for government health care. But I am trying to get the point across that it is a *moral* imperative to assure access to health care just as it was a moral imperative to assure access to education back when the nation was facing that crisis.

Really, my main point with this post was to share my moral revelation about the importance of this issue. Instead of just saying, "whatever" or "let everyone fend for themselves" I decided to take a real position.

Anonymous said...

Rae Ann,

there is more joy in heaven over one lost sinner who repents ...

er, conservative ;)

CIP

Anonymous said...

dhammett,

It's not like this experiment hasn't been tried. Essentially every other advanced country has some form of government health insurance, none pays more than about half of what we do, and people are pretty happy about their health care in the best systems (France, for example). Almost all of those countries have better national health than we do, as measured by infant mortality, life span, etc.

CIP

rafa said...

Dear Rae Ann

In Spain the Social Security is manadatory for both employers and employees. Employees pay up to 6% of gross salary. 4.8% goes to full healthcare coverage and a National Retirement Plan. 1.2% helps you if you get unemployed (up to 18 months. Not full salary of course). Access to healthcare is universal no matter if you're unemployed or homeless. No need to say the system is pretty expensive in terms of taxes. It is not up to you if you want to have public healthcare or not. Even if you can afford private healthcare (extremely expensive) you have to pay that 4.8%. There's no distinction between those paying and a homeless in terms of doctors, hospitals or any healthcare resource. Public healthcare system is the same for both. You can expect a high standard of talent within the system with very good prepared professionals. The trade off is the waiting list for a non extremely urgent surgery is huge. In this case, and if you can afford it, you can switch to a private surgeon, but the government will pay you nothing.

Have a nice day

r.

Why unmotivated?
All the best

rafa said...

PS.

Sorry. I forgot to mention the Healthcare System is pan-european. If you are on a holiday trip in France and you get sick you just go to the nearest hospital with your spanish health-card. Once again the system has good and bad things.

best

dhammett said...

CIP -

Any evidence of this happiness in all these other advanced countries or is your statement anecdotal? What is the cost of these systems that are working so well? Frankly, to add another federal tax onto what the government is already soaking me for is not exactly what I want to do. Now, if you were to re-direct some of the thousands of dollars I (we?) pay every year that goes towards a failing education system, I might be more amenable.

How does a national health care system do any better than what we have currently, between private insurers and the Medicaid system (for those who cannot afford health insurance)?

Rae Ann said...

CIP, don't get too excited just yet. ;-)

Rae Ann said...

Rafa, thanks for explaining the Spanish system. I'm sure it is expensive in taxes and that is one of the biggest concerns here. And that is why ultimately I'd like to see a solution that isn't purely governmental. As it is now, nearly every angle is corrupt, so it's hard to pick one that is the least of the evils.

For the typical US employee the taxes withheld are the income tax at whatever percentage bracket the income fits, Social Security at 6.2%, and Medicare (elderly health insurance) at 1.45%. And the employer also matches the amounts for Social Security and Medicare so the total taxes on a salary are 12.4% and 2.9%. Many people forget or don't realize that their employers also pay those taxes in addition to what is withheld from the paycheck. It's very expensive to have employees!

Yesterday I was just daydreaming too much and that's the reason for the "unmotivated" mood. ;-)

rafa said...

In Spain (throughout the rest of Europe the system is very similar) the employer pays *more* than the employee. So if you want to hire a new employee, planning a gross salary of let's say 'S' the total gross cost then for the employer will be around
TC= S*1.25 (that's the rule of thumb)

That's why I said the system is very expensive, for both, employers and employees. It works very well, but frankly speaking it is very expensive.

Best

so needly now? Uhmmm :-)

r.

Anonymous said...

dh -

This link has a lot of info (as of 2000). See especially Table 1 which directly compares cost, infant mortality, life expectancy, patient satisfaction, and a bunch of other stuff for most advanced nations. The US ranks relatively poorly in most categories, especially per capital cost (very high) and infant mortality (ditto). It also ranks fairly low in patient satisfaction.

CIP

The Guy said...

CIP always reminds me of that old saw "figures don't lie but liars sure can figure"

As Dh pointed out there are already a number of services in America which reflect a minimal, baseline service in emergency health care (which many illegal aliens exploit to get free general care) but CIP's cute little study from Maine does not reflect upon this fact at all. Furthermore that study simply assumes that if one is uninsured then one gets 0 health care. I'm uninsured and I get all the health care I need.

Your thinking is good, and moral Rae Ann and does you credit. But are you entirely correct in your basic assumption, that Americans don't already have what amounts to almost universal health care?

dhammett said...

CIP -

Thanks for the link. I took the time to read over the information it provided and am left with several thoughts. First, I trust the WHO as far as I can throw them. They clearly have an agenda. Nevertheless, the article breaks things down to essentially three criteria: good health for one's entire life cycle; responsiveness on the part of the medical community; and fairness in pricing, that is, those who can afford to pay more should.

The third point really sticks in my craw. Do those who pay more get more for their dollar? Hospitals and care providers are already shifting costs at the expense of tax payers and the insured (from your arrticle). If I make more money than you, should I pay more for my loaf of bread than you do? Sorry.

The article notes that the higher cost of health care in the US is, in great part, a result of higher administrative costs. It's hard to imagine a government administered program being more efficient, but I won't argue that point. Suffice to say the increases in the cost of Medicare and Medicaid are outstripping the increases in the costs of private health care.

It also notes costs are increasing because more hospitals and other care providers are becoming for-profit rather than non-profit entities. That's capitalism, my friend. They have every right to do that.

The article also referenced higher technical and prescription costs. Research isn't free. How many medical advances are coming from all the other industrialized countries?

France, according to the table from the WHO that was provided in the article, has the number 1 ranking in health care performance, yet only 65% of their population is satisfied with their medical care. Must be the people who are paying more than their fair share. Some people are never happy.

Yet in Denmark, 91% of their population is satisfied with their health care, but it ranks only 34th according to the WHO (the US is ranked 37th, by comparison). I guess Danes are just easier to please.

The infant mortality rates referenced in the article carried the caveat that racial and regional issues effect this statistic. That's lifestyle, not health care. Regarding the entire health cycle, the article cited high rates of HIV, violence, coronary heart disease and tobacco related illnesses as contributing factors to the US performance. Again, that's lifestyle, not health care. As an aside, if somebody smokes their entire life, then contracts cancer, why should I, who have made better choices, be saddled with the costs necessary to prolong their life?

Your study clearly had a bias. The WHO ranks the US number 1 in responsiveness, but the article anecdotally dismisses this, simply saying part of the population is still not covered. The article proposes no solution to the crisis, except to suggest that the Medicare/Medicaid programs be expanded to include everybody. That was well thought-out.

A couple of other thoughts:

In France, health care workers make 1/3 what the same workers make in the US.

In Canada, most of the population carries additional medical insurance, to cover conditions not covered under the national health care program.

To whom will you offer universal health care? Will you include illegal aliens? Do convicts get the same care law-abiding citizens do?

Universal health care creates disincentives for people to shop for the best buy in health care. It also encourages people to overutilize, going to a clinic for treatment for a headache, for example, when a couple of advil would work just as well.

Physicians have less incentive to provide competitive care (item no. 2 in the three WHO criteria). And drug and medical equipment manufacturers have less incentive to develop new meds and treatments.

You libs are already paranoid about the government invading your privacy. Health care records currently enjoy very special protection under federal law. Yet now you're telling me you're willing to give the government complete access? How does that work?

You may have a right to health care, but you have no right to get into my pocket to pay for it.

Rae Ann said...

Hi rafa! I think that "needy" is kind of a natural result of too much daydreaming. ;-)

Hi Guy! Thanks, and you've challenged me to refine my thinking, and that's always a good thing.

I want to come back to this topic when I have more time, but I have been thinking more about it and have some better ideas that need a little more thought.