Monday, August 3, 2009

Initial Thoughts


OK, let's get started...

Usually I would include all sorts of web links in this post. But in the interest of brevity, this time I'm going to follow your lead and just put my thoughts out there. If you want proof, I'll furnish the links later.

First up, on an important side issue, I don't share your belief that illegals are a burden on the system. As a matter of fact, I think the overall contribution by illegals to our society has been and is now generally positive. With a few necessary exceptions and relatively painless rules, I would advocate a general amnesty for all illegals currently residing in the U.S. In short, I would give them an attainable path to U.S. citizenship. You can continue reading after you have stopped shaking...

If you and I are going to design a plan which works, I think we first need to define the problem and then decide exactly what we are trying to accomplish. While this may sound prosaic, it is in fact crucial.

Thus far, most of your comments appear to treat health care like any other commodity which may be the subject of a government hand-out. Your approach mainly addresses the potential harm to society which may occur when "no strings attached" welfare has the effect of creating a sub class of social parasites. Specifically, the producers are taxed to provide unearned benefits for the non-producers. You want to create a system of rewards and penalties which will not only encourage personal responsibility, but in some cases mandate it.

As usual, I sympathize. But I take a slightly different view.

Broadly, health care reform takes aim at several fundamental issues. Leaving ideology aside for the moment, consider:

1. Compared to other industrialized countries, health care in the U.S. costs more and does less. It is, in short, overpriced.
2. Health care in this country subjects otherwise self supporting citizens to unacceptable levels of financial risk.
3. Somewhere around 47 million citizens have no health insurance at all, and millions more are under insured.

Conservatives are trying to frame the issue of health care reform as "socialized medicine", with all the accompanying images of an arbitrary, big brother government achieving greater control over our daily lives. THEY (government) will then virtually decide who lives and who dies. And woe to him who doesn't vote Democratic. Personally, I think this is a crock.

Statistics show the plain fact that we spend at least twice as much per capita on health care in the U.S. than any other industrialized nation, and in some cases 3 times as much, yet we rank near the bottom of the list in terms of performance. Insurance companies spend up to an unbelievable 47% of every premium dollar for non-medical expenses. Otherwise normal, hard working citizens who pursue healthy lifestyles are subject to an arbitrary lottery. They experience debilitating accidents or develop cancers, the treatment of which not only wipes out life savings but also renders them uninsurable for the rest of their lives. Low income families face the high cost of insurance and have to make difficult choices. For those who gamble on either no coverage or coverage with impossibly high deductibles and exclusions, this means they often cannot afford "wellness options" such as regular check-ups or relatively inexpensive treatments which would ordinarily be undertaken in the initial stages of various medical conditions. These are the people lined up outside our emergency rooms, waiting for expensive treatments which would be absolutely unnecessary had they been able to get treatment earlier. And, adding to the already tragic dimensions of this problem, it is the tax payer who is going to wind up paying the bill anyway.

So all of this isn't just an issue of fairness or what the role of government should be in our lives. Mostly it is an issue of simple economics. In this country we already spend in total at least twice as much as should be necessary to provide health coverage for every single citizen - regardless of income or social class. More to the point: if we do this right, we have the potential to cut health care costs by a whopping 50% and still provide universal care. All that savings could go back into the economy to fund any number of more productive enterprises. Heck, what entrepreneur wouldn't lick his or her chops at the aspect of around a trillion dollars of added consumer spending? It seems to me we shouldn't be talking about the financial burden which government proposes to place on businesses. Instead, we should be talking about the financial windfall which rational health care reform will give them.

As you requested, in the weeks to come I'm going to provide all sorts of ideas on how we can get health care spending under control, provide better coverage and extend it to every citizen. But (and this is important), I don't intend to engage in time wasting dust ups over ideology. Let's try to make the case based on economics first.



1 comment:

  1. Quickies:

    1. I did not limit retributions to "illegals", but specifically mentioned "non-citizens". Yes, there are specific 'punishments' for illegals. My compromise objective is to provide the initial care (once) and make an honest attempt to address future and/or continued mis-use of the system. This is very Important and cannot be ignored, because whatever system we design is not intended to provide quality Health Care for the entire planet at OUR cost.

    2. It goes without saying that the problem of illegal immigration is a topic meant for another series. However, I believe that - like our tackling of Health Care - it is possible to develop a compromise approach to Address the Problem without having to resort to purely ideologically-based, either-or proposals.

    3. I'm going to set aside the middle of your post as justification changes are needed. We agree there. The devil is in the details of WHAT and HOW.

    4. I very much agree that a 'financial windfall' to the economy is possible. However, if we are going to seriously consider the issue of Cost and Benefit, we *must* consider that government-provided Health Care AT ANY LEVEL is an Expense to the Taxpayers. Minimizing that expense is critical to proper functioning of the economy. Therefore, a proper and functioning set of check-and-balances (rewards and penalties) are certainly reasonable and necessary.

    5. There *must* be limits to what is provided at No/Limited cost to the patient. And, therefore, to provide at least the potential for TOTAL care AT ANY LEVEL will, in my mind, require a functioning PRIVATE component. A government-run and mandated monopoly on health care will inevitably lead to a downward spiral (e.g., rationing) where NO ONE is 'better served' and The System functions solely as a legal means to provide for an ever-increasing bureaucracy, ignoring the original goal of providing critical care.

    More to come. Nice start.

    - Steve