Wednesday, July 1, 2009

Another Socialized Medicine Rant (Now With More Words!)

I am 100% against turning over American health care to the government. I have this opinion for several reasons, but the biggest (by far) is that I don't trust the government not to screw it up royally. Because that's what governments do. Amtrak. The U.S. Postal Service (which seems to have retained many of the inefficiencies from its time as a governement entity). The IRS. The Veterans Administration. Is there anyone who believes the government can do a good job running a business?

The above paragraph serves as enough of an argument for me personally, as I see it as the common sense argument against government healthcare. That's not to say there aren't a lot more arguments against it.

Proponents don't like the term "government-run healthcare" or "socialized medicince" because of the negative connotation they (rightfully) believe people associate with them. Many proponents like to refer to it as simply "universal healthcare" and (my favorite) "free healthcare". Simply put, nothing the government ever does is free. The government runs on tax money, and everybody pays taxes. I know a common refrain from the right is that taxes fall disproportionately on the producers (i.e. the rich and the middle class) while those lazy poor people get everything free. That's true to a point; income taxes do fall disproportionately on income earners. The disparity widens as one earns more; that's why it's called a progressive income tax system.

The truth however, is that everyone pays taxes in one form or another. Sales taxes, property taxes, hotel taxes, capital gains taxes. Of course there's all kinds of things out there that we don't call taxes but have the same effect. We might call them procesing fees or registration fees or whatever, but they amount to money we pay to the government to get a building permit or license our cars or a million other things.

The upshot: there's nothing free about socialized medicine. Taxes will be used to pay for all this coverage, which means everybody is paying for it. It's all sleight-of-hand: you don't pay as you go, you pay well in advance. What happens when costs go up and the system needs more money? I'm sure you can guess, but we'll explore it anyway a bit later.

Another argument in favor is the inherent unfairness a private system gives us. The quality of care is dependent on how much coverage you can afford. Insurance companies deny claims to reduce costs. This leads to 45 million Americans not having health insurance (though there seems to be some dispute as to whether that number is rising or falling). I grant that all of the above is true (except I don't know which of the two articles linked in the previous sentence is more accurate). I still wouldn't advocate switching to a socialized model.

That some can afford better quality is something we accept in every other facet of our lives. Yes, I can afford better health coverage than my unemployed (and completely fictional) cousin Jimmy who picks up construction work whenever he needs beer money or the next Halo game comes out. I can afford a nicer car, a nicer house, nicer clothes and a bigger tv than him too. So I have a personal doctor and get biannual physicals while Jimmy goes to the walk-in clinic only when he thinks he might be dying.

Ah, you say, but cars and tv's and clothes are niceties. Healthcare coverage is a right. To that I say, no, it's not. Wherever did you get that idea? Politcal posturing and rhetoric aside, I can't find anything in the U.S. Constitution or Supreme Court case law that would convey a right to free healthcare. And I should point out that in every hospital in this country, if my cousin Jimmy stumbled into an emergency room and was about to die, U.S. law requires the hospital to treat him even if he stumbles in screaming, "I'm dying and I have no money or insurance!" Note that this law doesn't mean healthcare or insurance are rights; if Jimmy walks into said clinic with a sprained ankle and announced his inability to pay, the hospital would probably work out a payment plan, but they would not be outside their rights to tell Jimmy to hobble on out of there.

As to the propensity of private insurers to deny claims in order to keep costs down (or, if you prefer, increase profits), what makes you think government wouldn't do the same thing? As the population ages and healthcare costs rise, government will have to control costs. How can they do this? Well as I alluded to earlier, they can raise taxes. The other option is to ration care. Sounds like denying claims to me. Factor in government's endemic bureaucratic inefficiency and pretty soon we'll be Massachusetts. Or Norway. Or Canada. Or Britain. The linked articles add a lot to the already bloated word count of this rant. The short version is this: governments aren't good at controlling costs and so have high tax rates and ration care in order to make up for their fiscal irresponsibility. Whee!

What about those 45 million uninsured? Well, when you take out those that are eligble for Medicare but haven't applied, those who can afford insurance but choose not to buy it, and illiegal immigrants, it turns out the number shrinks significantly.

Now, you may be thinking, "I can't believe I wasted all this time reading this. It'd be nice if he had an idea to fix healthcare rather than just bashing everyone else's ideas." Touche. My only response to that is, here is what I would do. Oh snap.

First, end employer-based healthcare as it currently exists. I say this as the recipient of what may be the best employer health plan in America. I don't pay for jack. My daughter was on antibiotics for almost two years as an infant due to a medical condition that couldn't be corrected until she was two. I never paid a dime. Pharmacists used to run my insurance information multiple times because they thought it was a mistake that the amount due kept coming back zero. No co-pay, no deductible. My daughter ended up needing two week-long hospital stays, one of which included the surgery. Out of pocket I paid zero. I tell you this not to brag, but to show you that what I am advocating would cost me some kick-ass coverage.

The downside to this is that I am disconnected from the cost of healthcare. My decision to go to the doctor is not based on whether I really need to go. My employer picks up the tab, so why not go? Maybe I'll score some percodan for my acute back pain! In all seriousness, I don't go to the doctor for every little thing. However, it's more a function of stubborness and having better things to do with my time. The reason I don't go unless I really need to should be that I don't want to waste money or file an insurance claim that could negatively affect my rate for something trivial.

Right now companies use healthcare as a benefit. The coverage comes in lieu of more pay. I advocate companies paying more in direct compensation, allowing the employee to use that money to purchase their own coverage. This has the benefit of letting the individual make decisions about their healthcare based on direct knowledge of the cost. No more going to the emergency room because you have the snifles. Now you would have to decide for yourself if you want to spend the money on elective visits. You'd pay your own premiums and make decisions accordingly. Right now people with coverage like mine go to the doctor for all sorts of minor things that normally would handled through rest and over the counter medicines. Why not? The company's paying for it. When healthcare is "free" for everyone you can expect the same mindset on a national scale.

This would also address another problem. Right now, insurance companies bend over backwards to make companies happy. They work with hospitals to get reduced rates on procedures, office visits, and prescriptions because the company represents huge numbers of insured. Think of it like a bulk discount on health care. Those costs get made up somewhere. In this case, "somewhere" is a town populated by individuals who buy health insurance without the benefit of a corporation negotiating on their behalf. If health insurers were competing for individuals instead of companies, the same forces that exist virtually everywhere else in the marketplace would take hold.

The other action I recommend is overhauling Medicare and Medicaid by eliminating the waste inherent in the system. Prosecute fraud and abuse of the system and fund it as the safety net it was meant to be. These programs have a place. I believe it is society's duty to take care of those who can't take care of themselves. I also believe that it is society's duty to make sure the definition of "can't take care of themselves" is as narrow as possible and to keep the number of people who meet that definition small.

There. I fixed healthcare, right? Of course not. Not even my tremendous and well-deserved ego is that big. But I believe in the idea that the free market, even with its inherent problems (primarily, that profit is the primary driver, sometimes at the expense of the customer) is infinitely better than a government-run alternative. The government hasn't given me any reason to think they can balance a checkbook. How could they possibly run a business?

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