Reform or bust
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Published: December 4, 2008
Waiting for the other shoe to drop can be an agonizing experience. Case in point is the renewed discussion on health care.
Aside from the truncated plans in the early days of the Clinton Administration, there hasn't been a serious attempt to reform health care in this country.
First we got the socialized medicine bogeyman. Then the argument that government-run health care plans elsewhere led to long lines for service.
Those might pass as valid arguments except American health care costs about twice as much per capita as health care anywhere else in the western world and delivers worse results in terms of all the standard objective criteria, like average lifespan, infant mortality rates and so on. No wonder supporters of the corporate health-care establishment use scare tactics. The facts are not on their side.
Do you want a bureaucrat making medical decisions for you, they ask? Well no, but how is that different from the actuarial department of a giant insurance company making the decisions?
You'll have long waits for care, they threaten. Try that on someone who delays seeking care because they can't afford $5,000 in out-of-pocket costs or a 20 percent co-pay on a $10,000 surgical bill, or the family with private insurance who can't afford the emergency room so they hold off seeking medical attention for a sick child until regular office hours on Monday morning.
The losers in "socialized" medicine are those who can afford whatever they want, whenever they want it. They're the same people who, after running the country's financial system like a personal ATM, are now running to the government to bail them out because they're losing money.
What's a $5,000 out-of-pocket fee to someone wearing a $5,000 watch, who can doctor-shop at the finest private clinics in the country?
But what of the Joe Six-Packs the GOP so like to trot out when it suits their purposes? He and his family win big from almost any kind of health-care reform you would care to name.
Let's just look at the cost shift. As health-care costs have risen, more and more people have had to do without insurance. That takes them out of the preventative health care routine — things like annual checkups, mammograms, colonoscopies, and even routine teeth cleanings are beyond their means.
Instead, they tend to appear in the emergency room at the local hospital when there's a crisis, and emergency-room care is among the most-expensive treatment options for most any health problem except trauma, which is what it's designed to respond to. But someone without health insurance can't begin to pay for routine care, let alone emergency treatment, so to make up that money, everyone with insurance pays a little more. Similarly, the government pays less than the cost of services for Medicare and Medicaid patients, so those with private insurance, primarily those who are insured through their workplace, pay more still. The combination is commonly referred to as the "cost shift."
Under a universal plan, everybody shares the risk by paying into one health care pool, and everybody shares the benefits of reliable, modestly priced care. In a single stroke, mandatory health care eliminates a vast chunk of the cost shift, saving Joe Six-Pack and his family a tidy sum every paycheck and eliminating the burden of spiraling health-care costs from small- and medium-sized businesses. Full government funding of Medicare and Medicaid would remove the rest of the cost shift. It also puts the have-nots back into the preventative care routines, reducing the amount of pricey critical care they are likely to need.
Now that businesses are finally advocating for reform as a way to control health costs, there's a good chance something will be done early in the next Congress. It's long overdue. And don't let the bogeyman scare you.
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