By most estimates, at least 47 million Americans are without health-care coverage. Millions more are at risk of losing their coverage because, quite simply, they can barely afford it and losing it is better than losing their home. Thousands more will be severely financially impacted by a serious illness because their premiums and co-pays amount to more than they can pay or insurance companies issue a post hoc denial of benefits.
An important question in the debate is whether this is the best we or any society can do. Obviously the answer is "no." But another question strikes even deeper and at the heart of American politics, if not identity. It is: Are the best interests of a business always coincident with the best interests of an individual? The answer to that question seems almost obviously "no" in some cases, therefore "no" in the general case.
Health care and social assistance is a $1.6 trillion industry. That number is staggering. It accounts for a significant portion of the services that compose 55% of our economy. According to the 2000 World Health Organization report of health care around the world, our expenditure is #1 in the word, we are ranked #37 overall (right behind Costa Rica), and #72 for the level of health we achieve (right ahead of Bhutan and right behind Argentina). So, while the industry has been recording record profits and unprecedented wealth, we have been achieving the dizzying heights of wellness of countries like Bhutan.
Health care has been left in the hands of the free market for at least the last 35 years, since the Nixon administration, and in that time we have seen an escalation in the price of nearly every medical/wellness/social service or product while the health care/services industry has ballooned to almost unfathomable prosperity. All the while the numbers of people left without care they can afford or without care at all continue to swell. Don't forget, all those who were lucky enough to receive care/service have joined the ranks of the Bhutanese.
So, what are the arguments against universal health care (lest we forget that all best health care systems are government run and do more with less money)?
Position #1: Government sponsored health care is tantamount to socialism.
Response #1: OK, is government run firefighting tantamount to socialism? What about the Postal Service? If they are, is that a reason to privatize all fire departments? There are services that citizens need that most agree should not be withheld if they can't afford it, like fire fighting. The previous is a good working criteria for what services should be public. Hell, I'll pay for my postage if that means that people can see a doctor.
Position #2: A free market solution will save us money and give us the best care.
Response #2: The free market solution has not served us well to this point, why again should I place my faith in it? The best business model is to collect as much money while providing the least amount of care. That is what we have now. We are charged significantly for care we don't receive. Granted, world renowned experts practice in the US. Unfortunately, most of us can't afford them. Remember, US free market solution has given us Bhutanese level of health, now those are results.
Position #3: The government would be bankrupted.
Response #3: See Response #2 on how well the free market is doing. Admittedly, much would have to be done by way of tort reform to limit damages against the government. But with people given wellness and sickness care from cradle to grave, overall medical expenditures would come down as health improves (much the same way numbers of fires go down when we improved fire prevention and response infrastructure: detectors, sprinklers, etc.) There is plenty of fat to be cut out of our current federal budget. After all, how many Osprey's does the USN/USMC really need? Or, do we really need a federal department to tell old ladies to take their shoes off at the airport?
Position #4: People could afford health care if they just spent wisely.
Response #4: That is true but it is not true for all or even the majority of people without access to care. American economics is complicated but there is an alarmingly and increasingly applicable catch-22 that many don't want to admit. Our economy is as robust as it is because people spend beyond their means and many businesses need that to be true. Put differently, if Americans spent and saved wisely by living within their means, our economy would collapse. Put yet another way, the American economy presupposes consumers will be saddled with debt for goods that consumers will have to spend a lifetime working off. And let's face it, health care can't be repossessed so why should it be funded with a loan. (Note: the politics/economies of debt is worthy of further of discussion that will occur in a future post)
We can do better as a country. We are willing to sink trillions of dollars into wars every 15 years but we can't seem to come up with the money or will to take care of our infirmed? If war metaphors are the only way to motivate action, then where is the war on preventable illness, or infant mortality? So, instead of falling prey to the rampant demagoguery out there, give me the argument for why all of my countrymen should not have health care. I am happy to oblige with a response.
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9 comments:
I think this may be the best one yet. I think we she move to France. Canada may be more reasonable.
The fear of socialism is complicated but essentially it rests upon a false promise. The promise is that we all have this uniquely American opportunity to be profoundly GREAT (very wealthy.) What value does a promise hold if it is practically unattainable? Are we really willing to do away with the well being of 98% of our population to maintain the hope (as if the hope in itself is worth the cost) that each of us may be a Bill Gates? Um.... but each of us won't be a Bill Gates. In fact, Bill Gates can not exist without the suffering masses. Call me red but I'd rather we all have medical care. I'm willing to part with the idea that I might one day control a large percentage of our nations wealth at the expense of everyone financially beneath me if it means that all of us can attain the most essential aspect of freedom and happiness.... health.
Countries with socialized medicine are no worse off. Their over all care is actually better!
If the top 1 % of the population in those systems want something that can't be done within their system... they can come to a country with the best specialists to get it and pay the big money for it. Only a small percentage of people would ever be able to attain this sort of care so why build a system for everyone around this ideal which caters to so few? As you pointed out, even in our own country only a small percentage of the population can receive the BEST care (the bill gates of medical attention) anyway... so why not give the rest of us a bit more security and let the rich have their magical medical care elsewhere if they need it. This shouldn't even be a debate. We have become a nation which doesn't provide for it's citizens the very thing for which we have willingly signed away so many of our freedoms .....PROTECTION. Personally, I'm a bit more frightened of cancer than I am of suffering a terrorist attack. Again people, lets start facing the facts, the statistical facts and move our government to truly protect us in a way that will actually be needed in most of our lifetimes! How easily bamboozled we are! Shame on us all!
Ditto, my favorite and much-loved cabbagehead. I refer to it as the "sickcare industry", rather than the "healthcare industry"; designed to make us sick, or keep us sick. It's all about the money.
Chris, this is a fantastically written and very insightful analysis of what is clearly our national "shame" (as you rightly call it).
I was particularly impressed with your comparison of healthcare to the postal system or firefighting. It has never occurred to me to make those comparisons which, now that I think about it, are quite obviously analogous.
I used to teach Marx in my ethics classes and often heard many of the arguments against "socialized" medicine that you list here from my students. I think Marx is helpful in elucidating one of the basic truths that we (sick) capitalists forget too often, that is, that "healthcare" is not a luxury and one ought not have to "afford" it. When I ask my students "what is it about being wealthy that makes a person 'deserve' quality medical care more than someone without means?" they have a much harder time defending their reductionist views of capitalism-cum-meritocracy. I am teaching Marx again this semester in a 19th C. Continental class, and I intend to completely steal your (firefighting and mail systems) analogies here.
Also, I love this blog and I check regularly for updates. I haven't been able to comment much because I am so swampled this semester. (I'm teaching 3 classes this semester--my first time to do that ever. I've got a class on Feminist Philosophy, one on Justice, and then the 19thC. class.) Anyhoo, keep up the good work!
Chris, It looks like you have some good agreements to your post. Good on you. I will give you a conservative view point on this issue. I, don't agree with you on your solution, nor your assessment of positions.
Is our postal service really that good? I think it has become much better after it recognized it couldn't compete with the likes of UPS and FEDEX and has "joined" FEDEX in order to become competetive in the express parcel delvery area. I don't want health care to be run by the government. I think that it will become MORE of a failure rather than less. I also don't want any current or former employees going "healthcaral" (i.e. postal) when they get frustrated with their jobs. The fire department and police do provide a great service to our nation, I will not argue. But to compare the fire department, police department, and the postal service to healthcare is comparing apples and oranges. The government routinely fails in providing services, Social Security for example. This issue is too important to risk failure by letting the government alone take it on.
I would agree with you that something needs to be done. However, with the country's best interests and the future at heart, we have got to do it right! With the stakes so high, we can't afford to get it wrong, because the bailout will be unaffordable.
You and I have personally discussed the British "free" healthcare system. The British are only mildly more happy with their health care situation than Americans (my apologies to Canadians, Mexicans, etc) are: 25% to 17%. Do you really suggest that we trade for that type of system which may leave us with 75% of the population dissatisfied? Please read Tim Harford's book (referenced below) to get further information on problems with the British healthcare system (he has a NICE example in the book).
I think that there is a market failure in the health care industry. Where there is a market failure, government should step in to level the playing field. In this instance, I agree with Tim Harford (The Undercover Economist, ABACUS Books, 2006 Ch 5 "The Inside Story" pp. 111-138) that the main failure in this market is incomplete information (Asymmetric Information in Economic terms). The information that is missing when determining prices for insurance is the health of the individual. Without complete information on the health of an induvidual, the insurance company cannot fully determine the risk of covering an individual. The insurance companies have tried to come up with this information, but the collection of information is incomplete. The incomplete collection of this information may be due to privacy laws (which I would be loathe to change), people lying to get a cheaper rate, or people not knowing their health history (to include the health history of parents). Anyway, insurance companies come up with a system that generates a price for insuring the masses. This price will probably be too high for those that are young and poor (picture a recent university grad at his first job) and they would be willing to forgo that cost so that they may use that money for housing or a better car. This price would be just about right for a middle-aged person or family in a median income bracket and they will probably buy the insurance. The aged with health problems starting to mount, will see this price as a true bargain and will buy the insurance. As time goes forth from this example, you can see that the price will eventually go up since the aged will be using the insurance at a rate that far exceeds the use of the middle-aged families. This will cause the middle-aged families to be priced out of the market.
Government has tried to intervene in some industries by requiring that health insurance be provided by the employer. One problem with this solution is that we shouldn't expect our employer to pay for our health insurance anymore than we should expect a house or car. The other BIG problem I have with employer provided coverage is that the employer buys a group plan to fit all employees without regard to each employee's preferences or needs.
The suggestion that I would propose is that we imitate Singapore's example. Singapore uses a Medical care saving's account program. In my proposal, each citizen would put in a nominal amount, say $2000, each year into a saving's account. The $2000 would be tax deductable. The account would be guaranteed to earn interest at a higher rate than other savings accounts, yet reasonable. Each time you go to the doctor, you would debit the amount from this account. The people that cannot afford the $2000will be subsidized. For catastrophic problems, insurance will be purchased by the individual, again those that cannot afford will be provided. Since these events cannot be reasonably foreseen, we can assume that each person has approximately the same risk, therefore, the price for the insurance will be the same for everyone. It can be seen that for the average person, assuming we have set the correct nominal amount, will easily cover a young person with plenty left over. This will grow over the years and will be able to provide for the higher costs later in life. After 70 the amount can be sued as the person sees fit. At death, the amount can be rolled into the account of a spouse, partner or children. The user of the savings account would be allowed the choice of any doctor. However, if a catastrophic event were to occur, one would be relegated to the doctor provided.
This program would necessarily eliminate medicaid and maybe even medicare. The loss of both programs would probably be enough to foot the bill for those that cannot afford coverage and leave some extra for the deficit if the government so chooses. I think that both programs are huge albatrosses that need to be purged before they break the bank.
In the end, I think that the Singapore example would work great in the United States. Yes, there would be some wrinkles that would need to be ironed out, but those would be minor in comparison to the problems that we have now. I think that with this proram, much of the bureacracy and adminstration that was created with the current system could also be purged. At present, U. S. citizens spend as much per person on the administrative costs of our system as the British spend per person per year on their entire system.
If you would like to learn more about Singapore's terrific system, please go to http://www.ncpa.org/studies/s203/s203.html and http://rru.worldbank.org/publicpolicyjournal/summary.aspx?id=261
Please excuse my writing, I haven't written this much in about five years. I hope that you find this information helpful and infomative.
As any economist would, I must end by saying that all of my examples are "ceteris paribus." And I owe heaps of credit to Tim Harford.
Cheers, Tom
One other item Chris, exactly how did our economy get out of the Great Depression and the drawdown following WWII if not by spending and saving wisely??????? If every economy were to collapse by spending and saving wisely, nearly every economy would be in shambles. Oh, what an economic fallacy you have here. I would encourage further study in economics (I have provided you the link) prior to your future post on "the politics/economies of debt". In this case, your argument against position #4 is invalid since our economy wouldn't collapse.
I propose that I provide you some help on economic issues in exchange for some help on philosophical issues? I hope that you take me up, I think the philosophical experience that you can provide will help me as I complete my M.A. in Economics.
Thanks for the inspiration, I haven't been this fired up in a long time.
Just a quick response to the economic collapse point. Our economy after WWII was very different, as you know, because it was industrial production oriented. Today, our economy is service based, especially financial services based. The average American has about $10K in credit card debt, plus auto loans, educational loans, mortgages, and other consumer debt. My point is that if folks were to start spending/saving wisely then the large number of companies who provide those services would no longer be needed, those employed by those companies would lose jobs, etc. (Oversimplified for brevity.)
Secondly, spending and saving (not investing) would reduce demand across the board, but especially in elective purchases. So, those companies selling optional products and services would be definitely be impacted.
I am willing to concede that "collapse" may slightly exaggerate the effect, but I maintain that there would certainly be a major economic correction, and I don't merely mean at least a 10% decrease in DJI. President Bush understood this when he said that the best thing Americans can do in the wake of 9/11 is go out and spend. The planes brought down the towers, but not spending would have brought down what they represented.
But, more on this later. Thanks for the great comments. I'll be reading up on your recommendations.
No offense to "economically speaking," but I am afraid that s/he is suffering from a gross misconception about the reality of health care costs.
Here are (only a few of) the many reasons the Singapore model will not work here:
(1) Two grand a year in savings is not a "neglible" amount of money for those about whom we are speaking, i.e., the presently un- or underinsured. As Chris noted, MOST Americans-- not just those living in abject poverty-- are saddled with debt which makes ANY savings almost impossible, not to mention savings that may amount to something like 5% or more of their income. People for whom $2000/year is a reasonable savings sum are the same people who can afford healthcare now. Your argument reminds me of another argument that I hear often and find inexplicably dense-- the argument that says, "if you are finding that gasoline prices are crushing you financially, then the best advice is to buy a hybrid vehicle." The truth is, if you are already in the situation where $3/gallon gas prices are a real burden to you, then the option of purchasing a new car is not even on the radar of posibility.
(2) Even if we were to grant that people actually *could* save $2000 a year, that allows them to have ONE AND ONLY ONE major medical incident before the whole Singapore-model-house-of-cards falls down. One hour in any emergency room in the country will cost you far more than $2000. And what of the people who have chronic illnesses (and, thus, chronic medical costs)? I am a diabetic and it costs me about $2000 EVERY EIGHT WEEKS just to purchase the things I need to stay alive (insulin, syringes, test strips). That's not counting any doctor's visits, which are of course necessary as a preventitive measure to avoid my disease becoming even MORE expensive. Unless your plan also reckons with the exploitative, predatory and, frankly, immoral pharmaceutical industry, then the $2000 that people have every year is useless. But, of course, that would involve federal regulation, which you obviously are unwilling to consider.
(3) Collectively, we are getting both older and sicker. And the oldest and sickest among us are the least capable of paying for that. Further, as those of us who may be young and healthy now progressively get older and sicker, we will be arriving at that life stage with more debt and less capital/assets than the generation who is populating that demographic now. Oh yeah, and we probably won't even be getting the meager Social Security checks in the mail to offset the immense burden we will be placing on our children. Your "Singapore suggestion" doesn't take into account any of these basic facts, which are just a few of the many elephants in the waiting room right now.
(4) Finally, a remark about your suggestion that "each person has approximately the same risk" for an unforeseen "catastrophic medical problem." Even a cursory glance at sociological, antropological and, yes, even economic literature should disavail you of that illusion post haste. Poor people and minorities are at greater risk of not only "catastrophic" medical problems but also the mundane, everyday medical problems than anyone else. Which means they are at a greater risk for being effectively bankrupted by the cost of staying alive. Which means that there will never, EVER come a day when insurance companies set the premium rates for everyone the same.
Apologies in advance if this reads overly-polemical... but, like you, I am also "fired up" about the topic.
The savings of which I speak would necessarily have to be in the form of a payroll tax. This isn't a voluntary savings account. It is absolutely mandatory, otherwise the plan would not work. Same with the Catastrophic Medical insurance. I have simplified it a bit, but one must assume a starting point. I want to rid this country of poverty, not by rooting the people out, not by bringing them into the middle class (if there is such a thing), but by ensuring they have the basic necessities of life. As for the economic reading, that is ALL that I read. As I asked Chris, I am open to reading suggestions. I just want to get the healthcare issue taken care of and done the right way the first time. Maybe the "best" time to have done this was in the 90's when Hillarycare came at us the first time. Had we come up with a compromise then, we would not be in the dire strait that we find ourselves in now. Bottom line on the health care issue is that we need a plan in which everyone receives care, everyone has a choice (of a provider), everyone has a voice in their care, and that "free riding" is eliminated. I ask you to look at the websites that I included. I read them again last night and I know that the plan as in place in Singapore would not work here, with some tinkering, it would.
As for cost, we must be willing to give up some of the things that we as a nation enjoy today to continue to reap the benefits of our labors in future. In order for us to pull our nation and other nations out of poverty, we MUST be willing to "invest" in that aim. In that investment, I don't think that we will necessarily endure a lower standard of living here. Hopefully we will keep the same standard or a moderately increasing one. We have, as a nation, lived too long as a consumption nation. We must find our way to balance this consumption with savings. Asian nations have weathered recent economic crashes by being prepared through saving. We must rise above the notion that something new today (especially on credit) is better than our retirement, our health, or our homes.
Sorry for the rambling. I must get back to work on my research paper. At least these economic discussions provide some impetus to further studies.
Cheers,
Tom
Hey man, good points overall. The government imposes sanctions on countries around the world because of the way that country "does business". I don't see a difference on something similar to the Healthcare/Insurance giants. Why can only rich healthy people get insured?
I agree with capitalism, it works, and it has been proven to do so over history. There is no reason why the insurance companies can't get rich, it is their right to do so. Business ethics is laced into laws that protect Americans and punish those who abuse it (Enron). My question is.... why isn't this unethical? I agree that people who are sponsored or pay for insurance, receive some very good deals. However, the doctors on the other end of the deal get screwed. The company gets richer while the client and the doctor get poorer.
Somehow, if all businesses had to institute some level of health coverage, and the health insurance companies where forced to cooperate through government mandated legistlature, it might help. Government subsidies, directly, wouldn't work to reimburse the companies of any losses they may incur. I mean, the point is to help Americans without bankrupting the economy. Instead, provide better tax breaks for business owners.
A "small" business would receive better tax breaks than larger lucrative ones, who can easily afford a good health-care plan. I'm not sure if any of this already exists, but if it does, it sucks ass and is broken.
Most hate the idea of having to pay for a government instilled healthcare plan, and for this reason only: People take care of themselves and others don't. My argument is, why should I pay for a 30 year, pack-a-day smoker to get chemo or surgery. If someone is grossly obese by choice (meaning not related to any glandular condition or mental illness), why do I have to pay for thier optometrist, endocrinologist, and internist appointments and medications and procedures when they get diabetes and many complications. The funny thing is, I know I should, it doesn't make them bad people and I believe we are one nation under God. Being said, we are a free country where people are allowed to do that. A smoker getting lung cancer isn't any worse than the leather-skinned people at the beach getting skin cancer or the triathlete tearing an ACL.
The answer isn't easy. There really is no such thing as a free lunch. The wealthy need to take responsibility for the millions of Americans that have let them achieve their success. Realty giants, software giants, brokers, movie stars, or whoever is the richest of society would not be there if it wasn't for the consumers. Fiscally, the government should hold them more responsible for tax contributions. Single mothers, elderly, low-income should be given breaks. Why don't politicians make this happen? Because the country is too partisan, for whatever reason, it doesn't matter how, it just is. The baby boomers are still in power, but aging out, there will be a change someday, but I'm not sure in what direction, hopefully moderate and sensible. Dynasties have no place in higher offices, it is just bad for the country. We need to make methodical, sensible decisions over a period of time. A president needs to realize that 4-years is a very short amount of time. We don't have politicians that say, "You know, healthcare is not an overnight fix, and it may take 10 years to institute all the changes. Here is the 1 or 2 that I want to make during my term, and if they are successful, it will lead to steps 3 and 4 in my next term, and so on..." Talk about a political strategy to keep a congressman or senator in office, or a president for 8 years, but also, it mimics evolution. Evolution of species weeds out the weak and develops adapted beings. If nature does it, why can't our healthcare system evolve, gaining opposable thumbs and and erect posture? Why can't our government look 50 years down the road, past their own lifetimes? Because most people are selfish and would rather see the fruits of their labor, they want to see a finished product.
Universal Healthcare won't work with any president who isn't some sort of visionary or rebel within their party. It won't work because our politicians are selfish. They think that for all their hard work, they deserve to see the changes take effect in their lifetime. They don't take any gratification for their hard work, just the finished product. Politicians don't care about the people, they care about their egos. Universal Healthcare can only happen if America is inspired to really, and truly, create a world that is better for our children, even better for their grandchildren, and even better for their great-grandchildren.
America could be a model for society 200 years from now, it could set the trend of truly being what our fore-fathers meant for it to be. They had a young nation, that really wasn't a nation, and created one of the most amazing pieces of literature in the history of humans (besides the Bible). The Constitution was a document made to set the course of America for the rest of time. 230 years later, we think we have it all figured out and that America is a success. In my opinion, America is still struggling out of infancy, only achieving an elementary level of success that the Constitution envisioned. We are young, very young as a country. We are in a teenage rebellion struggling with identity issues, and we also hate our parents.
Healthcare, it may be the path to enlighten America to their potential. It may inspire the comman man to work hard for their country and once again, say the pledge of allegiance with pride. Right now, there isn't much for people to be proud of. We ignored the Katrina victims and helped the rich people of Malibu. We are going to kick our friends out of the country because they were born somewhere else. We have problems, starting with building a strong fence rather than strong legislation. It seems that the country is holding the citizens to a higher standard than the ones who run our country. As citizens, we have forgotten our rights and our powers, we have let democracy slip through our fingers. Our politicians spend more time in Washington than in their own states and have lost touch with reality. We LET them make decisions we don't like. We LET them waste our money. Instead of blaming them, we should blame ourselves.
You are truly right, American Healthcare is our shame. I want to blame politicians, and I will, because part is their fault. But I blame the people who don't vote or even know who their congressman is even more. I blame governers who don't act like mini-mayors of the U.S. Lastly, I blame America's mental crutch, the media, for corrupting the minds of the masses and catering their programs to the easily-influenced in order to boost their ratings. Our shame is more than Healthcare, it is ourselves. America shouldn't hold Washington to a higher standard, we should hold ourselves to a higher standard.
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