Health Care FactsThe democrats in congress are bound and determined to pass health care reform legislation this summer, and the republicans are set to resist them in any way they can. In such a partisan atmosphere, truth has been the first casualty. Politicians believe We the People to be stupid in the first place and gullible in the second, so neither side feels the need to be very truthful about the challenges we face in finding a solution to rising health care costs. Eleven years selling the stuff has given me a thorough understanding of health insurance, and I AM a zero base thinker. Even so I can not differentiate between the liars and the clueless. I can, however, see clearly that the debate we are having about this subject suffers from a dearth of accurate information. A few random points for clarification and discussion:
Reducing costs is the stated aim of both sides of the debate, but the obvious ways to do so are seemingly off the table. The two most important reasons medical costs are out of control are:
1) The consumer of health services does not pay for them, so patients have no interest in reducing costs. Actually, it is in the patient's interest to run costs up as far as possible, once the deductible or co-pay has been passed. It is common for patients to game the system. Within the current public insurance options, calling an ambulance to avoid the wait in the emergency room is common. This is mostly a medicaid or medicare problem, since most private plans avoid the ER for trivial or routine procedures, and will not pay for these frivolous charges. Yet government run plans are promoted as a way to save money. Are any of the government plans on offer even beginning to address such abuse? (The answer is "No.")
2) Malpractice claims have done a lot of the cost inflation, both in the cost of each service or procedure performed and the number or volume of services needed or demanded to be performed. No plans to reduce or reform malpractice in any meaningful way are in any bill with a chance to pass congress, and the president is not calling for any.
The 800 pound gorilla in the room is this - reduction in costs will require a reduction in services, especially in the last few weeks and months of life. All professionals agree on this point, yet it is almost never discussed. Costs can only be reduced by making patients pay more, or by providing fewer services to fewer people, or both.
Life is full of injustice. Government vs. private enterprise is the battleground. People of the right distrust government, people of the left distrust private enterprise. Both sides seek more power to control and deny services to patients, but neither side will face this honestly. Just about every public participant in the debate, on either side, already possesses a tiffany plan, so their mendacity is not fostered by any personal need for better benefits. They believe themselves to be in a class that will withstand this attack on our health care coverage. Congress has already exempted themselves - and their employees - from any changes to their own coverage, and democrats have protected their chief supporters, the unions, from any untoward change. What does that say about their truthfulness?
Misapprehension of mortality tables on life expectancy. It is often pointed out by the advocates of reform that American longevity is not the best on Earth. This seems to be a willful manipulation of the data by those who understand it, and cluelessness by the rest. Our mortality rate from birth is indeed down the list, but we also have a high rate of death from causes that will not be affected by health insurance. For instance, we have a higher murder rate among our young men, we have a high rate of obesity and diabetes. Clearly we are not about to outlaw gun ownership or fine dining, and our food banks are not about to change to a lower carbohydrate (read higher cost) diet for the needy. Factor out these causes of death, and America scores in the top three in the world by any other measure of mortality. But reading and comparing mortality tables is difficult, thus we are not privy to this information so we can decide for ourselves. Suffice it to say that we have the best survival rates from most deadly diseases, and the longest longevity in our populations from age forty onward.
Allocation of resources, public and private. Right now those who have insurance are those who pay a lot for it, either by direct payment or their employer does. Any public health insurance offering will of necessity see many current payers decline to continue to do so, knowing that the public plan will pick up the coverage. This is a major, though little appreciated, outcome of any government plan.
Pre-existing condition trap. Our praise-seeking political class is quite fond of pointing out that denying coverage for pre-existing conditions is a big part of the problem. But what they never mention is that, without the ability to deny such coverage, any younger healthy person would go without coverage, or buy the very cheapest plan, if they knew they could switch to a tiffany plan if (when) they become sick. Not addressing this fact makes a single payer plan, with every citizen being forced to have the same coverage, necessary.
Now that we have some version of a patient's bill of rights in every state EVERYBODY has access to health care. Some states are better than others, but in any of them the state owned hospitals must offer care to anyone who presents himself with a disease. Of course, hospitals charge more than any doctor, but many doctors will not treat patients without immediate payment. What this means is, like always, the middle class gets the worst deal, since they have assets to forfeit if they can't (or won't) pay their bill. The poor and the well off are fine, but the great mass of humanity in the middle often fall through the cracks.
These are weighty issues, and they must be addressed, but I have not seen anything being proposed in congress that realistically addresses the situation rationally. Rather it is being addressed demagogically. If we are to engage in cost cutting, we should know in advance - What SERVICES are to be cut? Until that subject is engaged, we are being lied to by the party in power. If they ram through a partisan bill with no support from the other side, that will be a tragedy.