Rather than finishing the education series, this post is a copy of a letter sent to a speaker I heard this morning on healthcare reform.
Mr. T. R. Reid, March 3, 2011
Thank you so much for agreeing to speak to our group – it was an honor. While not a jealous person by nature, have to admit I found myself a little jealous of the life you have lived; particularly parts such as walking two hours up a mountain in Nepal to talk with the local “doctor.” If PBS ever sends you out again, I would love to tag along, especially to provide the counter-point. While I philosophically agree with you that a moral society should provide healthcare for those who cannot help themselves, I fundamentally disagree on the best way to do that.
To frame my argument, let me start by saying that I believe capitalism is the only moral economic system. I suspect you would disagree, but for the sake of brevity here, please make that assumption. Secondly, while a moral society should provide for health care (and food and shelter) for the helpless, the government should not be the first safety net. By its very nature, government is not the most efficient at providing social services (is why we don’t have government provide food and housing for all). Private charities (such as the one you work with) already are providing care. Some people don’t give to charities because they figure they already give through government. If taxes were lowered and government was not the “first responder” perhaps people would give more to charities.
Ideally, those who are not helpless would purchase their own health care (as well as food and housing) with no third party intermediaries such as government, insurance or employers. It would still be necessary to have health insurance, but only for catastrophic events, similar to how most home and car insurance works. What we currently call health insurance is really pre-paid health care. With pre-paid health care, there is little to no incentive to use less care, making this system inefficient. Not only does the patient have no incentive to use only necessary care or to live a healthy life-style, under fee-for-service, the providers have an incentive to provide as much care as they can get paid for. This is exacerbated by the cost shifting that occurs because of the low reimbursement rates of Medicare, Medicaid and the charity care hospitals provide. Providers need to make as much money as they can on patients who have insurance and can pay above what their insurance reimburses. I once wrote a letter to a hospital who I think grossly over-treated my husband, stating that next time I entered their hospital, I would claim to have no insurance and look homeless, because then we would get better care – only that which is medically necessary. The sickest entity in that circumstance was the hospital’s bottom line, not my husband.
You mentioned a figure for people who die due to “lack of insurance.” Some statistics say up to 100,000 people die in the U.S. per year due to medical errors. The Hippocratic oath states, “first do no harm,” but sometimes harm is unavoidable even under the best circumstances. Because of the inherent risks in any medical treatment, including pharmaceuticals, I would prefer a system that is paid to keep me as healthy as possible, with the least care, such as a Kaiser HMO. You may say, “Government health care systems will provide preventive care.” That may be true, but I would be much more willing to trust private, (profit or non-profit) over government health care.
My only encounter with “socialized medicine” was the care I received while on active duty military. I was stationed in West Germany, so was dependent upon the care the military provided, versus being able to supplement with outside providers. Luckily my needs were minimal (and did not have my children while in the service – I heard the comparison was not favorable for the military hospitals) but even so, the little care I did get was substandard to what I received when I got out. To be a little personal, when I went to Planned Parenthood to get my birth control pills, they were shocked at what the military had prescribed to me – very outdated and unnecessarily high dosing. Similarly, I wore contacts when I went into the Air Force. After four years of A.F. doctors I had resorted to wearing glasses. Again, as soon as I got out, even as a student I was able to afford an optometrist who immediately got me back into contacts. I realize my examples are anecdotal, but even so, I believe they are indicative of how the two systems compare. Competition=effectiveness. It’s just human nature.
My main disagreement with “The Affordable Health Care Act (what a misnomer - it will be anything but!) is that I believe it takes us further and this time irreversibly down the wrong path. The first wrong turn for U.S. Healthcare was getting employers involved after WWII, then Medicare, followed by the Republican enacted Medicare Part D. (A main reason why we Tea Partiers are so upset with fellow Republicans)
From what I have heard, many of the countries you suggest we emulate now have to enact private payer reforms, i.e. going away from socialized medicine because ultimately, it does not work well. With that in mind, I believe it is foolhardy indeed for the U.S. not to learn from the mistakes other countries have made. Rather than trying to be Japan or Germany, let’s build on what we do right in this country. In The Truth About Obamacare, Sally Pipes relates stories of Canadians who come to the U.S. for treatment when “their lives are on the line.”
This morning you gave your point of view - the above is mine. As did you, I have made some broad assertions without much proof or evidence. While opinionated, I like to remain open-minded and discuss opposing points of view, as that is how I learn.
Lord Beverage, at heart