Wednesday, October 8, 2008

Dollars and Sense: Fixing Health Care

Being extremely liberal, it should come to no surprise that I have strong opinions in support of an effective and meaningful system of national health care. I understand the arguments against single payer, though I disagree with most of them. I believe that every administration in history has shown that it is willing to spend a fortune on its projects, so the argument that we simply cannot afford meaningful national health care is ridiculous. We can afford to fight two wars at once and send advisors to countries like the Phillipines and Colombia in the name of the 'Global War on Terror.' Perhaps if we eliminated the 'GWOT' as a major budget expenditure all of that money could be spent on health care. It's certainly worth thinking about.

Terrorism is bred by poverty, ignorance, lack of economic opportunity, and basic geopolitical conflicts between states and ideas. As such, it is not a problem to be directly solved itself but rather a symptom of the larger problems of the world. Terrorism is another form of international crime and it should be dealt with in that manner, rather than the wasteful use of military force. I do believe that nation building is required in Iraq and Afghanistan, but the best way to build a nation is to help the people build it themselves. If we build a nation in our own image, as we tried to do in Vietnam and Laos, the local citizenry will not embrace it. It will be ours, not theirs. So we need to reform our foreign policy and spend much of the money we are currently wasting on military operations at home.

Even the Republicans are talking about health care in this election, and John McCain's plan would sound good in the abstract if it were not for the fact that the two fundamental problems with our current system are not addressed. Costs are addressed, a $5,000 tax credit to buy private health care is great. It even has a chance of passing because it's the kind of pro-market move that Republicans like, and it means a tax cut of sorts, which Republicans also like. The problem is that, while costs are the biggest barrier to many people receiving health insurance, they are not even close to the biggest problem with the system.

The first problem with the current health care system is that the way the costs are shared. The employer-employee system of cost sharing puts an undue strain on business and only benefits the employees of businesses that can afford to match health care costs. I'm hardly the biggest fan of Corporate America, but business is necessary for our capitalist economic system. Even should we ever find the political will to step beyond liberal economics to a more Keynesian or Radical system, we will still need business and capital. A single payer system that eliminated the 'taxes' imposed on businesses by the current system would save American business more money than any corporate tax cuts the Republicans have to offer. It would also allow small business owners and employees to receive health care. Even a modified cost-sharing system with the government matching the contributions of both employer and employee would ease this burden and allow more employers to offer health care. At the very least, a program specifically set up for the government to match employee contributions for small businesses would relive the system of strain. Naturally, I favor more radical solutions and advocate single payer as the ideal. Single payer is the best system for solving the real problem of American health care.

The real problem is that we do not have a health care system, he have a health insurance system. Healthy people are required to pay for insurance, while healthy, to avoid onerous health care costs when they need health care. This means one pays every month whether one sees the doctor that month or not, to pay for the emergency room or urgent care visit three months in the future. The problem is that not all insurance is equal and that your emergency room visit may still carry a three hundred dollar co-payment, despite the fact that you have been paying for that visit for three months without ever visiting the emergency room. This is ridiculous. Many procedures and illnesses are not covered, under a variety of loopholes. Deductibles make the patient responsible for significant shares of the cost of a hospital stay of one week despite the patient never having stayed in the hospital before and yet paying for it every month. Out of pocket costs are frequently burdensome even with insurance. The system exists so that insurance companies can make money, and if the companies have to actually pay for too much medical care then their profits shrink. So high premiums, high deductibles, and a slough of co-payments are the defining marks of the system.

We have seen a significant financial crisis that has badly damaged our financial system, including massive insurance companies that chose to make extra money insuring mortgages. Keeping that in mind, can you see our current system continuing to work without large increases in premiums, deductibles, and co-payments with the insurance companies in such financial hardship and needing every dollar?

Dr. Arthur Garson Jr, MD, of the University of Virginia wrote a piece today that correctly defines many of the problems of health care that have resulted from our current system. Unfortunately, the solution offered is the same sort of political pap we have been spoon-fed by Washington for years. Dr. Garson recommends a multi-lateral commission in which doctors, insurance companies, and both political parties wrangle for five years (the number given is his) to try to find new ways to control health care costs. This is somewhat counter-intuitive, as a massive commission of this sort would generate its own costs for Dr. Garson's five years. During those five years, nothing would actually be done about the problem.

The insurance companies need to be removed from the health care management equation. Even if some version of our current system remains, a government definition of 'health care' needs to formulated and regulated. All companies wishing to provide health care must meet these standards. HMOs must be made to cover out-of-system care and PPOs must be made to cover necessary care of any kind when it becomes necessary. Bureaucratic costs must be controlled to lower premiums. Deductibles should either be disallowed or carefully controlled and co-payments should be reasonable. The Secretary of Health and Human Services, the Surgeon General, and senior aides from the Department of Health and Human Services and the White House should be able to handle such a project far more quickly and efficiently than any blue-ribbon commission. Certainly, the insurance companies should not be made part of the regulation process. We have seen in other areas just what damage can be done by industry insider regulators.

The best solution is still single payer, and ultimately I believe it to be the desired solution. If pragmatism requires smaller steps, however, there are things we can do right away to address the problem. Waiting five years for meaningful health care reform is ridiculous if a more streamlined process can provide it in two or three.

In case the right waves the red flag of 'socialized medicine' in front of the centrist bull, keep this in mind: socialism is the idea that a society should care for its members and its members should care for one another. This philosophy is voiced by nearly every religion and denomination on the right wing of American politics. The simple fact is that the government is the embodiment of society's power and is responsible to society. The 'law and order' that the right wing is fond of advocating can only be enforced by the government.

The biggest problem American health care faces is crime and anarchy. Law and order will not be imposed from within, it must be imposed from without. If this leads to socialized medicine, good. If it doesn't, it can still lead to specific improvements. American health care needs a systemic policy, not a financial crutch or meaningless 'reform' of the existing system. Real health care reform must change the current system radically, or it will not succeed.

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