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8/12/2008
Burri: Government-run health care is not the Holy Grail
In this corner: government-paid, single-payer, “universal” health care. In this corner: keeping government bureaucracy as far away from health care as possible.
The problem with the latter, we’re constantly told, is that sometimes people can’t pay for their own care. Sometimes insurance companies balk. Sometimes good, hardworking people who don’t deserve it find themselves caught between a devastating illness or injury and bankrupting, unreachably expensive medical care.
Since the “free market” – the dastardly, greedy, for-profit free market – isn’t providing every health care need for every person, we should have the government do it instead. Or so the thinking goes.
Universal health care! Health care for all!
But then you run across a story like this one:
The newspaper described the sad plight of Barbara Wagner, a 64-year-old Springfield woman with lung cancer.
After her oncologist prescribed a cancer drug that would cost $4,000 a month, the newspaper reported, "Wagner was notified that the Oregon Health Plan wouldn't cover the treatment, but that it would cover palliative, or comfort, care, including, if she chose, doctor-assisted suicide."
The government health plan refused to cover her treatments. They ran the numbers: the cost, the potential benefit, the woman’s life. They decided it wasn’t worth paying for, and instead offered to pay for doctor-assisted suicide.
That’s the juicy, tabloid-y part of the story: that a government bureaucracy would help a patient kill herself, rather than help pay for her medication.
Just for a moment, let’s pretend: what if this were a private, for-profit insurance company instead of a government bureaucracy?
Care to imagine what the reaction to that story would be?
Denying treatment to a dying woman, those money-grubbing bastards! Telling her to kill herself instead! Because keeping her alive isn’t profitable!
At the very least, it would become the biggest, baddest talking point in the universal health care armory. Get profit out of health care!
Except…this isn’t for-profit. This is the government. The all-knowing, all-seeing, all-feeling government that is supposed to Save Us All.
Which brings me to the really important part of the story (emphasis added):In Wagner's case, administrators of the Oregon Health Plan had to make a difficult call. But that's what they do every day in performing the tough, thankless job of rationing government-paid health care to the needy.
Rationing. Rationing government-paid health care. As if there isn’t enough to go around. As if health care were a bottle of water, and you, me, and Cap’n McEyepatch have at least two days of rowing under a blazing sun to make it to the next deserted island.
Tell me: if letting the government handle our health care costs is the way to provide “health care for all,” why would we speak of “rationing?”
Why can’t everyone just get the health care they need?
That’s actually an easy question, unless you’ve chained yourself to the idea that Government Is The Answer. Resources are limited. Demand – when consumers are protected from cost – isn’t. Therefore, no matter how much tax money they have, government-run health care will have to include some kind of rationing: decision-making about who gets what.
You wouldn’t know that, to listen to “universal” health care advocates. As far as they’re concerned, government-run care is the end-all. The brass ring. The Holy Grail.
But. Moving from private health care solutions to government health care solutions doesn’t prevent difficult choices. It doesn’t mean people never go without. It doesn’t create a health care utopia.
It simply puts the decisions into a different pair of hands. And those hands are less likely to be your own.
Lance Burri is a contributor to the Badger Blog Alliance and occasionally blogs at his own site as well.
COMMENTS
God bless Barbara, God help government, socialists, statists, and those who rebut personal responsibility. It's not cost, God help us.
Richard (Mon Aug 11 22:48:02 2008)
Even people with "private insurance" are shielded from cost. The whole system is warped because people do not have a true sense how much their tests, etc. cost, and costs are bumped up to cover overheads caused by govt red tape.
Many times, drs order tests due to the "invisible lawyer" at their shoulder, and this likely would not change if we have "universal coverage". So the answer is NOT INSURANCE, as insurance is part of the problem.
It would be better to have catastrophic coverage only, have tort reform, and allow drs to advertise their fees. E.g. if you need an electrician or plumber, you compare workmanship, along with price; and doctors USED TO BE ABLE TO DO THAT TOO.
Just think: people now can choose how much coverage to put on their vehicles, or their houses--but not themselves!?! Even those employers who offer a choice of insurance, have a very limited "choice".
Those who criticize our "system" as being "free market", claiming "the free market doesn't work" are (deliberately?) ignoring the fact that WE DON'T HAVE A FREE MARKET SYSTEM. But poorly as it runs now, imagine how much worse it'd be if the govt got their hands on ALL of it. To use the car example, imagine if everyone had "universal coverage" for their vehicles, that included repairs when the car broke down due to lack of maintenance! Now imagine, if the govt paid for it--how careful do you think they'd be!?!
Why do the proponents of "universal health care" think human nature wouldn't apply in that "special" case?
EMILY MATTHEWS (Tue Aug 12 10:30:52 2008)
Why is the United States today languishing in the penumbra of its relatively recent greatness? Maybe part of the reason is that some folks offer no ideas on how to solve the problems that are as clear as the nose on our face.
What? The universal health-care nose isn't clear? It's got acne? Quick, go to a dermatologist! What, you don't have health care?
You'd better watch that nose. It could be cancer. You don't have health care? See you at your funeral. Don't forget to invite Michael Moore.
It needn't be thus, as members of the Democratic Party's platform committee were told repeatedly at recent hearings.
It needn't be thus, as Paul Krugman wrote in his column in the New York Times yesterday.
Health care for all should be a no-brainer, Krugman wrote.
"What’s easy about guaranteed health care for all? For one thing, we know that it’s economically feasible: every wealthy country except the United States already has some form of guaranteed health care," Krugman wrote. "The hazards Americans treat as facts of life — the risk of losing your insurance, the risk that you won’t be able to afford necessary care, the chance that you’ll be financially ruined by medical costs — would be considered unthinkable in any other advanced nation.
"The politics of guaranteed care are also easy, at least in one sense: if the Democrats do manage to establish a system of universal coverage, the nation will love it.
"I know that’s not what everyone says; some pundits claim that the United States has a uniquely individualistic culture, and that Americans won’t accept any system that makes health care a collective responsibility. Those who say this, however, seem to forget that we already have a program — you may have heard of it — called Medicare.
"It’s a program that collects money from every worker’s paycheck and uses it to pay the medical bills of everyone 65 and older. And it’s immensely popular.
"There’s every reason to believe that a program that extends universal coverage to the nonelderly would soon become equally popular."
What, folks argue that universal health care would ruin the economy?
Has anybody noticed lately? The economy is already ruined.
Universal health care didn't do it. A $9.5 trillion national debt helped immensely.
George Bush also helped a great deal: a $500 billion budget deficit in the current federal budget, an incredibly dumb war in Iraq that has cost more than $500 billion so far, a lassiez faire attitude toward a bunch of "free-market" bandits who have freely robbed the financial system blind...
The list goes on and on. But universal health care isn't the reason this country is in the sorry state it's in today.
Krugman wrote that actually achieving universal health care would take three things: a huge Democratic victory in November, a catalyst that overcomes the public's fear of change and a vaccine against the next president and Congress getting cold feet.
"So I’m nervous," Krugman concluded. "The history of the pursuit of universal health care in America is one of missed chances, of political opportunities frittered away. Let’s hope that this time is different."
Rich Eggleston (Tue Aug 12 11:45:51 2008)
Excellent post Rich. You (and Krugman) are right on.
It's funny how we Americans can deny this country an opportunity to move forward because "somebody" who didn't work as hard or wasn't as lucky might get to tag along. That's what I call "compassion."
Emily, the tort system is not good and must be changed. But when physicians are up to eight times more likely to order tests when they own the laboratory equipment and the test is profitable as hell, you can't blame it on the attorneys. Blame it on the politicians who lifted the Stark conflict-of-interest laws.
As well, nobody is going to take their kids to the lowest bidder, so price transparency will have the exact opposite effect than intended.
Jack Lohman (Tue Aug 12 17:12:57 2008)
So you find one person who has trouble with the Oregon health care system? Pat yourself on the back. That's one versus the hundreds of thousands that have been denied healthcare under our current system.
Why "consumer-based" health care is a faux populist idea.
1) Think the screwing is bad under the sub-prime mortgage scenario? The predator economy will blossom with all kinds of bogus health care plans which will promise false coverage and leave "clients" poor...and dead.
2) Under this system private insurance keeps on doing what it's doing -- denying coverage for pre-existing conditions and finding ways not to pay claims, while tying up doctors for man-centuries on the phone trying to argue for coverage for their patients.
3) The is no guarantee that this system will lower costs. You have all the proof you want now with the current system.
4) The major problem we have now are minor problems left untreated growing into costly procedures. Yeah, high deductibles while encourage people to go to the doctor.
5) One of the major problems we have is obesity. Of course working people 60 hours a week, raising kids and other duties leaves plenty of time for exercise.
6) Tell me one COUNTRY where "consumer-based" health care has worked, versus the greater success of government supported plans.
If blowing smoke is medicinal, then praise the Lord we all are cured.
Keith Schmitz (Tue Aug 12 17:32:27 2008)
I would recommend reading "Code Blue- Health Care in Crisis" written by Dr. Edward Annis, former president of the AMA and the World Medical Association.
Dr. Annis, a graduate of Marquette Medical School, has been monitoring this very debate since at least 1960 while rubbing elbows with John F. Kennedy and Hubert Humphrey.
"...the problems in health care have a 'Made in Washington' label. Health care is the most over-regulated industry in America. Doctors and hospitals that deliver health care are strangled by senseless paperwork, counter-productive bureaucracy, and abusive civil court system, and price controls that are actually driving prices up. What we call a health care crisis in America is actually a crisis in government...
...that Americans enjoy the best medical care the world has ever known and that socialist systems control costs by denying medical services to some, by delaying medical services to many, and by stifling research and innovation."
Dr. Annis' book was published 15 years ago and obviously has the expertise of a medical insider.
While ChimpyBushHitler's popularity polls low, the U.S. Congress polls even lower. I wonder how the polls would rate bureaucrats? How is it that these people are the ones that advocates suppose will usher us into Universal Health Care Utopia?
Steve Burri (Tue Aug 12 19:14:38 2008)
Rather than reading a dated book with 15 year old thinking, I'd recommend "The Corrosion of Medicine: Can the Profession Reclaim Its Moral Legacy?" By Dr. John Geyman, a member of Physicians for a National Health Program (www.pnhp.org). His data is current and his solutions are sound.
Or consider others that are listed HERE: http://moneyedpoliticians.wordpress.com/books/
Jack Lohman (Tue Aug 12 19:48:35 2008)
So .. wait.
We hand health care over to the same kind of people that run the IRS. And this is supposed to make it better?
It is not the well-meaning who will run NHS for the first decade that worry me. They'll do as good a job as the law allows them.
It's the empire builders and chair warmers and 'crats who follow them that worry me.
Y'all folks who want the government to fix the Health Care Crisis consider this - Democrats won't be in power forever. Eventually the pendulum will swing back Republicans will be in charge of the government again.
Republicans will be in charge of your health care. Do you really want that?
Brian Dunbar (Tue Aug 12 20:14:17 2008)
John Geyman-
"8 Incremental efforts over the past 30 years to “reform” health care in the United States have failed to resolve major problems in access, costs, and performance. With each failure, policymakers and politicians promise that the next advance will somehow fix the problems. The list of failed claims is long: managed care in the mid-1970s, prospective hospital reimbursement in the 1980s, health maintenance organizations in the 1980s and 1990s. The latest promises include preferred provider organizations, consumer-directed health care and health savings accounts, and disease management and electronic information technology. All perpetuate administrative waste and profiteering, which are devastating health-care delivery."
There's a good start for arguing for government controlled universal health care. Washington has screwed it up for 30 years, so we should instead put the whole thing under its wise auspices.
Steve Burri (Tue Aug 12 20:27:27 2008)
So how are you liking our free market health care system now. We rank 37th in the world even after paying twice as many dollars per patient as any other country in the world.
Taiwan just revamped their system after studying every system in the world. They copied our Medicare system, which Dr. Geyman and 59% of the doctors in the US favor.
It's not perfect, but after spending 35 years in the health care industry I'd put it ahead of any private system out there. It would work even better if the politicians were out of it, but they are better than the shareholers that put profit ahead of patient care.
Jack Lohman (Tue Aug 12 20:54:03 2008)
""8 Incremental efforts over the past 30 years to “reform” health care in the United States have failed to resolve major problems in access, costs, and performance."
Absolutely! You don't solve this incrementally, this is major surgery.
By the way, let's come up with something more intelligent than "government can't do anything right." For every screw up you claim for the government I raise you two in the private sector. Let's start with health care financing.
Keith Schmitz (Tue Aug 12 21:32:00 2008)
"By the way, let's come up with something more intelligent than "government can't do anything right." "
Sure. How about: there are things our government does well, and things it does not do so well.
Responding to market forces, innovating, cutting costs, generating wealth - these are not things the government does well. If you want innovation, cost cutting and excellence in medicine, do not let the State own that function.
Brian Dunbar (Wed Aug 13 08:32:26 2008)
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