[politics] A few simple questions about healthcare

I’m back to politics, but I’m taking a different tack today from my usual snarky critiques. I thought I’d approach the healthcare reform issue from the top with a series of simple questions for people to think about. Some things to consider, no matter what your political (or apolitical) stance might be.

  • Do you or your family rely on health insurance through your workplace?
  • Would you have trouble affording COBRA extensions to your health insurance if you lost your job and did not have a paycheck to cover the premiums?
  • Do you or your family have any chronic health issues, such as diabetes, cancer, arthritis, and so forth, that would make finding affordable market-based insurance difficult?
  • Would you be under significant financial stress if you or someone in your family ran up thousands (or tens of thousands) of dollars in medical bills?
  • Do you have to think carefully about what you can afford before going to the doctor or the emergency room?

If your answer to any of those questions is “yes”, then even if you have good health insurance today, you stand to benefit strongly from a constructive reform of the American system of healthcare finance.

  • Do you or does anyone in your family participate in Medicare or Medicaid?
  • Do you or does anyone in your family participate in the VA health system?

If your answer to either of those questions is “yes”, then you already are part of a major government healthcare initiative. Medicare is a “public option” payer, following the Canadian healthcare model, that covers 45 million Americans today. The VA is a government owned and operated healthcare system following the British model, that covers millions more.

Ask yourself how Medicare and the VA have affected the American healthcare system. That’s all the “public option” does, which is to say, extend benefits already enjoyed by tens of millions of Americans of all political convictions to more of their fellow citizens without disrupting standards of care or physician choice or availability.

It’s all pretty simple. We can do more of what we’re already doing, and offer compassionate, life-enhancing medical coverage to everyone in our society. The real debate isn’t whether we should have healthcare reform, it’s how we should go about it that benefits everyone at the most efficient and responsible cost.

3 thoughts on “[politics] A few simple questions about healthcare

  1. I think these are excellent questions to ask.

    Here are a few points I would like to raise in response:

    1) Can we do this without putting thousands of people who are presently employed by the insurance companies out of work? Is there a way to shift them into other parts of the system? Because I know of a lot of people who haven’t the skills to do much else working as data entry clerks and healthcare administrators who would be out of a job without the insurance industry.

    2) Are enough people who actually work in the medical field like doctors, specialists, nurses, and administrators going to have a controlling interest in how this is run? If we’re smart, we won’t try to reinvent the wheel. I think Clinton did a fairly good job of welfare reform because he and his staff specifically went about looking for what worked and tried to use that. There are countries that have nationalized healthcare that works for them and then there are some countries that have almost bankrupted the government. I think Progressives see the ones that have worked and Conservatives see the ones that have bankrupted the government. People need the assurance that diligence has been sought here. We need a few Rock Star doctors and large hospital administrators to get behind a system. Right now all I hear are politicians, and I like a lot of other Americans don’t generally like those folks much (sometimes even if we do agree with them politically).

    3) Can we actually cover everyone? I don’t want to overhaul the system to find that the people we wanted to cover are still left out of the system. Every American gets coverage.

    3.1 – because I thought of it while revising) Can we make drugs cheaper without putting the pharmaceutical industry out of business? I think drug costs are a huge burden. I don’t mind footing the bill on Open Source R&D. Let’s make drugs the way some developers write software.

    3.2) medical malpractice arbitration – we need it. Something that doesn’t require a doctor to carry malpractice insurance that costs them over 100k a year. Not joking, that’s what many doctors have to spend to protect themselves from lawsuits. There needs to be wise governing bodies with clear heads in this part of the medical field.

    4) Is it possible for this system to work like the Postal Service so that it works competently and allows competition with companies like FedEx and UPS. And I should be specific here, because I don’t necessarily think that the system needs to continue to look like present day insurance. Personally, I think Insurance is something you need in an emergency. It shouldn’t be required just to get medical care. I think it’s an obtrusive gateway to healthcare, but it’s a part of our present reality, so there’s no ignoring its existence.

    Additionally, I hate that this has become a political issue. I think Progressives, Conservatives, and the rest of us can agree that our present system is not working as well as it could. People do see varying degrees of broken in this debate, but the questions you present here are the sort of questions our present leadership should be asking. Why aren’t they? This is important and I really don’t think they’ve been handling it competently. I think they are trying to rely on political momentum and not substance. With something this big we need real substance.

    However, I would also like to say that I want more people to critique the plan. Mind you, I want them to critique whatever it is based on facts–not, OH NOES Death Panels!!! You can’t really fight the lies though unless you have something solid to put in front of people that isn’t the size of War and Peace. This should be something that people don’t have to search to hard for — and I think the first place it should be advertised and looked over is Fox News.

    I know Progressives hate Fox News (is hate a strong enough word?), but it is an outlet that a lot of people go to for their information about current events. Many of these are opinion over fact, but I think you could get the right person there, someone who is a fighter (Thinking Dr. Dean here, who actually has written an excellent book on the subject of healthcare and has what I believe to be a pretty good plan), and they could at least start pointing people in the direction of truth. Obama needs to reach out to Fox News, otherwise he’s alienating a large portion of the public. Will they likely bite his hand? Yes. Should he just deal with it? Yes. He’s a big boy, and I think he can take it, because right now he needs to take it–no whining, just fight the fight.

    Excellent post, Jay. I appreciate it. And look forward to reading responses.

  2. I think a big part of the problem is that many Americans think ‘Healthcare Reform’ is code for ‘Socialized Medicine,’ wherein all docs, nurses, hospitals, clinics, etc, become state-run and state-controlled entities. I’m not sure the U.S. healthcare industry — or patients — will ever want to go down that road.

    As Shawn notes, it sucks that this is a political question. I think it’s political because of tax dollars. Single-payer coverage for all citizens will involve tax dollars, and a lot of people are very spooked at the idea of seeing their taxes raised in order to fund and run the single-payer system.

    Yes, self interest is a big part of that. Lots of people simply don’t want to pay more taxes in order to cover the currently uninsured. Many Americans believe that getting and keeping coverage is an individual responsibility. Which is generally where we can differentiate a lot of things, between conservatives and liberals: individualism versus collectivism.

    I think Shawn brings up a huge and often-overlooked problem: malpractice insurance. One of the docs I work with, and whose wife is a doc, just had to watch his wife spend several months getting taken apart by a needless and patently frivolous, money-grubbing medical lawsuit. She won, but it was an example of how docs basically have to live in fear of getting fucked by people who just want to use the courts to extort wads of cash out of the medical system.

    If we’re going to overhaul how we pay for people to get care, we should also overhaul how we handle it when people try to sue the docs and/or system.

    I’m fortunate in that I have access to two forms of coverage: my current coverage through my company’s program — I work for one of the healthcare organizations Obama cited recently as being exemplary — and I can also get Tricare through the Army Reserve, if I want it. Both of these are offered as part of my employee compensation, one from private and one from the military. In both cases I have to pay. These are not free.

    Which, again, brings up the fear many Americans have of seeing their tax dollars used to give away billions in healthcare dollars to people who don’t put back into the system.

    That might seem like a selfish fear, but it’s a fear that ought to be addressed in a non-dismissive manner if Healthcare Reform is going to be taken seriously. Is it fair, assuming Reform happens, to burden the middle and upper-middle class with the costs incurred by the lower and poverty classes, who won’t be paying anything?

    Part of what troubles many overseas programs — some of which are truly socialized in every sense — is that due to demographics problems, they’re now looking at having more money going out every year for healthcare, than is being brought in. There are more and more elderly and fewer working young to handle the taxes, and now these countries are trying to figure out what to do.

    In a way, they’re looking at the healthcare issue from the opposite end of the kaleidascope: having socialized, they’re trying to figure out if maybe some privatization might defer costs and get the disgruntled healthcare professionals off the government’s back.

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