[politics] Various comments on healthcare reform

A few responses from me to some interesting comments in yesterday’s healthcare post. (Worth reading the comments in their entirety, though I’ve trimmed them here for clarity as I respond.)

Shawn Scarber:

1) Can we do this without putting thousands of people who are presently employed by the insurance companies out of work?

I appreciate this problem, but speaking as someone who’s been laid off five times over the years due to working in unprotected industries (advertising and consulting), my experience is that job protection is rarely a priority in our economic decision making. Why do you think this particular workforce should be protected?

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?

Ghu, I hope so. That’s part of my point. The current dynamic runs like this:

Democrats: “Healthcare idea.”

What it should be is:

Democrats: “Healthcare idea.”
Republicans: “Different healthcare idea.”

Which would include, certainly, involving the medical field. See this excellent post on the same topic, taking a doctor’s point of view.

(And note that “different healthcare idea” can include, “keep the system as it is”. Not that I agree with that, but it’s a position that could be taken.)

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.

To me, that’s entirely the point of this process. See above, it needs to be discussed rationally and carefully.

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.

Unless we go to single-provider, which has never been on the table (despite Republican accusations to the contrary), I don’t see why it would be anything else but openly competitive. For that matter, people in Canada and the UK are free to buy private insurance, and some do, for various reasons. So do people on Medicare in this country. So, erm, yes, I don’t think this is an issue in the high level sense. As always, the devil is in the details, but until we get past the noisy, opportunistic “death panel” rhetoric, we’re not going to get much in the way of detail.

Additionally, I hate that this has become a political issue

Yep. All you have to is look at the public statements of people like Inhofe, Boren and Armey to see why it has become a political issue. They’re quite open about it. The GOP didn’t even slow down to consider this as a policy issue before they seized on it as a way to tar Obama and the Democrats going into the 2010 midterm elections and the 2012 presidential elections. They’re not bothering to pretend to principled objections to the proposed reforms, or even rationally discussing the need for a reform. Conservatives politicized this issue to make it DOA and to have a stick to beat Obama with.

Brad R. Torgersen:

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.

Absolutely. And what frustrates the hell out of me is that conservative political leaders and media figures only contribute to that perception, even though they certainly know better. Medicare is socialized medicine, so far as that goes, so is the VA system. So the Americans who fear “socialized medicine” have their fears and biases confirmed for opportunistic electoral gain, instead of participating in a rational debate about one of our society’s biggest problems.

It may be that just as only Nixon could go to China, only a conservative leadership could deliver meaningful healthcare reform. But I hate that this thing is quite likely to go down, not on the merits, but out of carefully cultivated ignorance and pumped up hysteria.

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.

Which would be fine, if coverage were affordable and available to individuals. I have an income in the upper quartile of American wage earners, but due to my cancer, I cannot afford coverage outside of nonqualifying employer sponsored group plans. Even if I could find someone to underwrite me, it would take at least 20-40% of my income, and not cover my core needs due to pre-existing condition exclusions. (Not the mention the catastrophic financial impact that lifetime maximum coverage limits will have on me in a few years, no matter how good my insurance.) The current system doesn’t allow many, or even most, individuals to get and keep coverage, and that’s a big part of what is profoundly broken.

I think Shawn brings up a huge and often-overlooked problem: malpractice insurance

And the rest of the First World seems to be able to deliver quality healthcare without that problem. Note that according to , entering the VA system involves waiving your right to sue for redress. It seems to function pretty well regardless. Meaningful malpractice reform would help a hell of a lot. See the link above to a doctor’s perspective for a bit more on this.

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.

And that may be a conservative-liberal divide. To me, as a liberal-progressive, one of the primary purposes of government (and therefore, by definition, tax expense), is to put money into places that can’t self-fund. Fire departments don’t pay for themselves. Neither do libraries. Or most roads and bridges. As a citizen, and as a moral actor, I have a strong interest in seeing my fellow citizens remain healthy and well-cared for, regardless of whether they can self-fund.

The first order implication of the widely-held viewpoint you cite is that people who don’t have money don’t deserve healthcare. To my mind, that’s immoral, unethical and frankly chilling.

On a more practical note, we already pay billions for those people who don’t put back into the system. They come to emergency rooms when they get sick because they couldn’t afford an $80 doctor visit. This is very well documented. We’re paying for it now, out the back door, and very inefficiently. We may as well make it work through the front door, where we can fairly manage and allocate tax dollars and medical resources. The alternative is closing emergency rooms and clinics to everyone who can’t already pay.

The other flaw in that viewpoint is that it ignores the fact that anyone who loses their job joins that pool of people who don’t put back into the system. Except for high net worth individuals, or the very healthy (and young), we’re all one layoff notice away from being in that very same position. Sheer self-interest ought to drive the most die-hard conservative toward a public safety net.

One thought on “[politics] Various comments on healthcare reform

Comments are closed.