The Health Care Debate: Injecting Reality

The health care debate is driving me nuts. It is typical politics at play, where each side takes up positions that are so radical that they know they will never work. Why? Because they will compromise somewhere in the middle. This gives them a chance to cover their asses when it comes election time. They will be able to look at their constituents, point to a change in the bill however minor, claimed that that was their doing, and bask in glory of reelection.

What gets lost in all of this is the human factor. Politicians assume that the public is stupider than they are. I know, hard to believe, but politicians are just that dumb. Politicians, after all, are those people who are good at winning elections. Winning elections, alas, has nothing to do with being able to govern. All too many of the politicians in Washington are marginal intellects and they live in fear of mobs who follow monosynaptic windbags on cable television and talk radio.

Let’s break things down. First, is there anyone who truly believes that some poor soul lying in the gutter, bleeding profusely, because some car has just hit him, does not deserve medical care? That should be a rhetorical question, but there are those who would claim that if that poor soul is not in the country legally or does not have insurance or, for you libertarians, can’t crawl out of the gutter to the emergency room by himself, he should just suck it up and die. In that way he would just be accepting responsibility for his own behavior which, in this case, involved being in a crosswalk at the wrong time.

I believe he deserves medical care. Some people suggest that medical care is a privilege, and since the Constitution does not mention it, it clearly cannot be a right. It is my sense that were medical science actually a science at the time of the founding of this country, the right to affordable medical care would have been inserted into the Bill of Rights. Caring for the poor and the indigent after all certainly is the Christian thing to do, a point often overlooked by those who claim that this is a Christian nation. (Matthew 25: 34-40 (41-46 for those who don’t believe me.))

What I find most revolting about the current debate is that it’s centered around profit. The idea that there might be a public option is one that is used to scare people into believing that they won’t get the care they deserve, and that the public option will put all of the insurance companies out of business. In short, enemies of the public option argue two diametrically opposed things: that the government is so inefficient it will not be able to provide people care, but it is so incredibly efficient that it will drive private business into bankruptcy. And a bonus: it will bankrupt the United States at the same time.

Clearly these arguments cannot both be true at the same time.

Since the goal is to make sure that people get the health care they need, putting together a plan should not be that difficult. The people are not stupid. There’s not a single soul in United States who believes that they will not have to pay for care one way or the other. Pretending that it will be free is just stupid. Everyone knows the politicians are lying when they make that promise. A public option may make it affordable. A public option may cause competition which drives down prices. But we’re still paying and we all know that.

So how do we fund this thing?

I have long been an advocate of something that I refer to as a health tariff. I use the word tariff to avoid that odious term tax. I don’t expect anyone to be fooled, save a few politicians. It works this way: for every bit of snack food, every bit of fatty food, or sweet foods or alcohol that we buy, $.25 is added to the price. Yes, I know this is a regressive tax. My thinking is this: if $.25 means you can’t afford a bag of chips, you can’t afford the health consequences of a bag of chips. This health tariff will force people to be cognizant of the daily decisions they make and the effect that their decisions have on their long-term health.

We collect the health tariff and put all of that money into one big fund. That fund is used to underwrite health care for Americans. It will not fund healthcare entirely and if people get smart it might go away, but that also means that people will be making choices which are better for them long-term, thereby driving down health costs. The health tariff is a simple variation on the old sin tax idea. We know that taxing smoking has not eliminated it, nor has it eliminated drinking. With the health tariff we will be getting some value out of destructive behaviors.

And at a quarter a pop, people who whine too much will just be seen as weenies.

Here’s the fun thing: if you don’t want to pay the health tariff, you don’t have to. Make an intelligent decision and you get off scott free. If you decide to indulge, to have those fries, then you pay.

Having grown up in a household where my father was a doctor, and having worked in his office while I was in college, I love the medical profession. My father and his partners worked long hours. Every year during the holidays I watched them write off tens of thousands of dollars in money owed to them by families who could not pay and yet were not eligible for Medicaid. They work very hard—you try telling someone their child has six months to live and see what that does for your day. They went in early, got home late and someone was always on call on nights and weekends and holidays so that patients in need of medical care were never left without.

That being said, for-profit medical care really skeevs me out. I understand that we don’t want our medical facilities to lose money. I understand we want doctors to be able to make a decent living. I know there are lots of things like malpractice insurance premiums that have to be paid, and medical school loans. The idea however that hospitals have become corporations, and have Board of Directors who have no medical training whatsoever, who treat medical care like a business the same way hog slaughterers treat pork, really leaves me cold. While the law may prevent a facility for refusing to take a patient, there are countless stories about individuals who do not have insurance being quickly turfed out to county medical facilities so the burden of their care falls on taxpayers.

In short, rationing of care already happens.

I think that for-profit medicine should go away. Not a question of my being a socialist, just a realist. Business models change. I know because I’m watching publishing change around me. 20 or 30 years ago I would’ve never had a worry in the world about my career after having 40 books in print. Now that track record means absolutely nothing, and this would bother me more, but I’m watching publishing stumbled blindly into an abyss – unable to change or to survive. And while some of you would note that being an author is entirely different than being a doctor, I would agree. I am not licensed by the state to dispense drugs or to do things which, outside a hospital, would constitute assault, battery, attempted murder, or negligent homicide. (You try removing a gallbladder in the street and see what sort of jail time you do.)

Medical professionals provide a service, and if you know any of them, you know the profit motive is not high on their list. Dealing with people on a daily basis who are having the worst time of their life is something for which no one can be compensated enough. Medical professionals feel a higher calling. I’m glad they do. They watch out for their patients as best they can.

As best the current situation allows them to.

About 10 years ago I visited the doctor because I was wheezing a lot. He diagnosed me as having asthma. But before he wrote that diagnosis down in my chart, he asked me, “How long have you had your insurance?” I asked why that made the difference and he said that some insurance companies give new patients difficulty over such a diagnosis. Again to the point I raised earlier, care is being rationed and healthcare individuals have to jump through hoops imposed by bureaucrats – private bureaucrats in this case – which has nothing to do with the care the patient needs.

So to me this debate is all useless. This is because the course is fairly clear. We need to provide care to everyone. We need to pay for it. Everyone knows they’re gonna be taxed on one level or another so we might as well have that up front. And we need a public option to provide competition so that prices will be kept reasonable. Anyone who argues that government corruption will make sure that that doesn’t work should explain to me how private corporation corruption is any better or works for anybody except CEOs being compensated in the millions by profiting off the agonies of millions.

I find it highly ironic that the politicians who are deciding the fate of the healthcare bill have one of the best healthcare plans in the nation in place, and have had their campaigns funded by those individuals who profiteer from misery. Conflict of interest, anyone? I realize that conflicts of interest are standard operating procedure in Washington today, and have been for, gosh, the last two centuries anyway. But now is really the time for politicians to strap on a pair, defy their corporate masters, and actually do the job for which they were elected: which is to see to the greater welfare of the people of this nation.

And as for those insurance companies and others who wish to profit, they’ll do exactly what has been done with Medicare. They’ll set up supplemental insurance to cover the things which Medicare will not, and facilities to do the procedures that are not authorized by national healthcare. They will still be around, they will still make their money, but not so many people will suffer to pay for their country clubs, their second and third vacation homes, and their lavish vacations to places others can only dream about visiting.

This isn’t rocket science. Give us what we need, give us a reasonable means of funding it, and it will all work out.

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13 Responses to “The Health Care Debate: Injecting Reality”

  1. Very well said. You really should be the one to bash the politician’s heads together and make them see sense (I would pay to see that)

    I live in Scotland so am lucky to have the NHS. While the NHS gets a lot of criticism and it is far from perfect, I have had mostly positive experiences with it (especially when I have really needed it) My son spent four days in hospital recently with breathing problems and he got great care.

    In the UK you can get private health care if you wish, but I am so glad that I do not need to worry about having to get this in order to get health care.

    I do hope that there is a positive outcome of the healthcare reforms proposal.

  2. Mr. Stackpole, I’ve been a fan of your writing for some time. I’ve always appreciated the talent that some writers have to take the ephemeral notions we all share in our minds and give them verbal form.

    There is something unmistakably genuine about what you’ve written here, and while I can’t say you’ve changed my mind, you have reminded me that things like this really do matter.

  3. Christine Grosvenor 28. Aug, 2009 at 11:49 pm

    The last thing I expected to see when visiting your page was a rant about health care, but I’m glad for it.

    You’re exactly right. Can you represent me in the Senate? lol

    My brother-in-law is a very hard working surgeon and has a hard time paying back his student loans from medical school and supporting his family at the same time. It doesn’t help that his family tries to live above their means, but I think that a man who dedicates his life to saving the lives of others deserves a Playstation 3 if he wants one.

  4. I must differ with the idea of a ‘public option’ as a solution. I like your idea of a way to fund it, essentially taxing those who are most likely to use the service, but I fear that the costs of any system run by the government will spiral out of control. Will a public program put the insurance industry out of business? Not by a long shot. Medicare, the closest thing we have right now to a public option, is incredibly inefficient and patient hostile. Payments to physicians are so low that patients have difficulty finding doctors who will take them.there’s a reason that insurance companies can make money offering ‘Medicare plus’ plans. They operate far more efficiently. Yes they limit some patient choice, but not any more than Medicare does anyway. As a surgeon, I have far less difficulty getting procedure approved by an insurer than I do navigating the maze of medicare regulations regarding what is a ‘medically nescesary’ procedure. And forget about being responsive to changes in the patient’s or doctor’s situation. I have had patients wait YEARS to be reimbursed for Medicare errors. I personally went unpaid by medicare for six months because I had the temerity to change my billing address to a location different from my primary office. For the amount of money that will be spent on this ‘public option’ we could likely buy everyone in the country a good if not great commercial insurance plan. Insurance companies are an easy target right now but an objective look at their operations will show that the are much better at delivering care than Medicare. They make money by investing your premium, a hard thing to do in the last few months, which is why they are looking for even more efficiencies. They don’t take your premium and funnel it into the CEO’s pocket. Two sepatate money streams. Yes, they try to make a profit. That also means they look hard at how much they spend on administration and unneeded treatments. Why should we expect a government program for everyone to be better?

  5. And I’m going to argue that you equivocate too much in the beginning in an attempt to appear reasonable. The left isn’t really being too bad here. They have a sane, reasonable plan they’ve brought to the table. It will work if given the chance.

    And then there’s the right, with its wailing and its gnashing of teeth and its repetitive, pervasive, and sickening lies.

    Good call on bringing up Matthew 25. That’s a hard one to dodge, and it clearly shows the disconnect between Christianity and Conservatism.

    A sin tax on unhealthy foods isn’t a terrible idea, but it should be considered that (unlike cigarettes) there are safe and unsafe quantities of potato chips. Especially as they are now often prepared with oils low in saturated fats, they can easily be incorporated (with moderation) into a healthy diet.

    A flat tax per item would also unfortunately impact the $.99 grab-bag market, which is generally a healthier way to get your fried-food fix than the large $5 bag (which would now be even more cost-effective.)

    Better would be to tie it to quantities of trans fat, of which there is no safe amount. It would be a financial burden on people so poor they are forced to rely on margarine to be sure, but the stuff’s frankly nasty in at least two senses of the word and the faster we drive it out of our supermarkets the better.

  6. I agree w/ Bruce Davis above. I like your idea on how to fund health care. I do not like the public option. Medicare and Medicaid have increased, not decreased, the cost of H.C. There’s no empirical evidence that suggests increasing public intrusion into H.C. reduces cost.

    That said, I am for a safety net for those who cannot pay for their own care. I’m not a libertarian. I do believe society has an obligation to help those who cannot help themselves. But we need a better system of providing a way to pay for these things than the current methods, which are, quite frankly, bankrupting our country.

    We cannot pay for the entitlement programs we have *now*. The entire entitlement system needs to be reworked. Not abolished, but revisited in total. But no politician will volunteer that, Bush trial-ballooned that in 2000 and it nearly torpedoed him. Like him or hate him (and I think he was savaged unfairly but did an underwhelming job) he was right to address that issue. The bottom line is, I don’t think a public option as its being bandied helps anyone though I agree we should do more to help those who are here legally.

    SWG

  7. Its so true. My best friend and I have argued about this many times. Personally I totally support health care for all if most of Europe can successfully get away with it why can’t we?

  8. JediBear wrote: “Good call on bringing up Matthew 25. That’s a hard one to dodge, and it clearly shows the disconnect between Christianity and Conservatism.”

    I can see where this idea comes from, and while I don’t totally disagree, I think there is some perspective and clarification need when bringing Christianity into any discussion of government. It is true that Christians are commanded to care for the poor and the sick, and many of us have been doing just that in various capacities for last couple thousand years.

    However, everything changes when you start talking about *government* doing something. Christianity also teaches “love your enemies” and “turn the other cheek,” but that doesn’t work practically when you’re facing a totalitarian dictatorship bent on conquest. This is a big reason that, as a Christian and a conservative (generally), I’m unhappy with the conflation of the two. I definitely think Christians should be involved in government and base their actions on their beliefs (after all, they’re not beliefs if you don’t act on them), I don’t like people using Christianity as a marketing tool.

    So, that said, what does this have to do with health care?

    We have to consider several factors. First, as Mike stated in his original post, we need find a way to bring down cost while providing people’s needs. Second, we have to consider if a national-government-sponsored solution is the best way to do this.

    The second point is where I think the debate has failed. People forget that we have a written constitution for a reason: to limit the power of the national government. Arguing that we as a society need to provide health care is not the same as arguing that we need a national solution.

    Nationally-provided health care is unconstitutional *not* because health-care isn’t a right (the Bill of Rights has never and does not limit our rights to those few amendments, per the 9th Amendment) but because the national government does not have the authority to enter that arena. It falls way outside the 17 enumerated powers and would require such a great stretching of the 18th power (the elastic clause) that it’s fairly ridiculous.

    The key to all of this is the oft-neglected 10th Amendment: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.” Under the Constitution, health-care should be the realm of the individual and the states, not the national government.

  9. Mike

    As an Australian, I find the US health system and the subsequent debate about “Public Option” bewildering to say the least.

    In Australia we have both public and private health care. Everybody is eligable for public, not everyone chooses to use it.
    To fund this we pay a tax of .5% of your basic salary if you earn more then the threshold (I think the threshold is about $35k AU). If you earn more then $75k AU, and you don’t take out private insurance, you pay an extra 1% tax.
    The idea is that the very low income earners don’t pay anything for health care, middle income earners pay a minimal amount, and high income earners who choose not to take out private insurance pay extra.

    In practice this means that everyone, rich or poor has access to health care. Having (or not having) insurance only comes into it with regard to “elective” surgery. You can still get elective surgery for free, but there is a waiting list, or you can pay for it either out of your own pocket or from your insurance and get it done immediately.

    The system certainly has its faults, but it also ensures we don’t (to use your example), have people, who after being hit by a car are refused treatment, or asked (in their semi comatose state) for the insurance details.

    I do not understand why such a model, or similar is treated as one of the seven signs of the end of the world by you guys. I do not understand why cost is such a concern. We are talking about human lives here, both in quantity and quality.

    I do wish you luck with getting the problem resovled. Sadly I don’t think you will. Your system seems be held hostage by too many groups each pushing (or holding) their own agendas to the exclusion of all others.

    Michael

  10. How about if we expand the Veterans medical system. I have used them for over sixteen years and have found them to be more than acceptable in general medical care.

  11. I have been a diehard fan of your writing and RPG works since the late ’80s. However, I’m not in favor of the mandatory Public Option that Congressional Democrats such as Steny Hoyer and Nancy Pelosi are trying to shove down our throats. Federal health programs such as Medicare and Medicaid ended up costing taxpayers much more than Democrats originally budgeted, and I don’t think the federal Public Option will work any better. I’ve already had problems dealing with existing health and human services bureaucracies: waiting times are usually twice what they tell you on the phone before you arrive in the crowded waiting areas, and today I actually had to wait 30 minutes just to have my case worker and doctor authorize my prescription drugs. You also seem to confuse Libertarians with Objectivists in terms of their attitudes toward indigent people; have you taken the World’s Smallest Political Quiz at to see where you fit on the Nolan Chart?

  12. I should add that I’m not opposed to a voluntary Public Option, just like the U.S. Postal Service is the voluntary public option for parcel delivery. I’m simply against the “individual mandate”, i.e. mandatory coverage achieved by forcing individuals to join. There are roughly 45 million uninsured Americans; how many of that number would join the Public Option voluntarily, and how many are independently wealthy people who prefer to pay their own bills out-of-pocket? [These are some of the real issues I have with Pelosi, Rangel, Kucinich, et al.] Finally, don’t confuse Objectivists with Libertarians in their attitudes toward indigent people; have you taken the World’s Smallest Political Quiz at TheAdvocates.org to see where you fit on the Nolan Chart?

  13. One of the problems with all government-run healthcare systems is sustainability. That’s especially true for “single-payer” systems. There just isn’t enough feedback to keep usage to a reasonable level.
    In Japan, for example, until a few years ago health care for people over 60 was free. (Everyone else is on one of two government plans where you pay either 20% or 30% and the government pays the rest.)
    They had to change that, because people were going to the doctor because they didn’t feel well. Which sounds reasonable until you realize that at 80 years of age there’s always going to be _something_ wrong with you. You might even feel bad just because you’re lonely. I think they started making seniors pay 10%.
    Even with the people paying, on average, 15% of their salaries (7.5% for company employees because the company pays half) and then 20 or 30% of their healthcare costs, the Japanese public healthcare system is gradually running out of money. They can’t raise taxes enough keep it solvent.
    That’s the problem.
    It’s better than the British or Canadian systems, because there is more fiscal restraint built into the system, but it’s not sustainable.
    There are problems with the current system in the U.S. as well. But that doesn’t mean we should move to a system with a built-in bottomless hole that will suck our economy down.