Define the Health Care Debate

From QuinnsCommentary

The health care debate rages on yet we have barely started. At one end of the spectrum we have those who desire a government run system with no private insurance and at the other a hands off policy letting free markets work. Both are wrong and neither will solve the problem. But exactly what is the problem? No, it is not the uninsured, it is cost and quality. Cost is the main driver of the uninsured problem. Poor quality is a primary driver of costs.

There are those who argue that government has no business mandating that individuals obtain health insurance and on its surface, one may see the logic. However, not having health insurance does not mean not receiving health care which someone has to pay for, that someone being those who do have coverage, the taxpayers and some health care providers who are unable to pass uncompensated costs along to their customers. Unless we are prepared to let people go without health care if they have no money as they do in China, it is our business when people choose the no coverage option.

At first glance a government solution appears an easy answer; everyone is covered, just like Medicare and Social Security. And it is also tempting because once costs disappear into taxes they largely go unnoticed, again just like Medicare and Social Security. But costs are there and sooner or later they will impact tax rates and the economy, just like…you get the idea. With any broad based mandate or government system unless we solve the cost problem first, we are just asking for more, not less trouble. One might also argue that the track record of government in terms of efficiency, projecting and controlling spending is questionable or that leaving health care decisions to an ever changing Congress is problematic. Here is an example, the Alternative Minimum Tax was established after it was discovered that 155 Americans had escaped all federal tax legally. Today after years of inaction tens of millions of Americans are affected. But for many Americans government remains the right answer for health care because they see the problem as the uninsured.

What should we attack on the cost front? In no special order, malpractice costs, inefficient systems and information exchange, incentives to provide care like physician ownership of laboratories or other facilities, easier and quicker access to generic drugs, health and wellness education, the “discount” structure that distorts the true cost of health care via provider networks and the various incentives that encourage over utilization of health care and a disregard for costs, advertising by health care providers and drug companies as if they were selling refrigerators, state mandates that add as much as 25% to the cost of health insurance thus helping it to be “unaffordable”…just for a start.

Let’s not delude ourselves, even with 100% accomplishment of our goals, costs are still going up because of an aging population, our desire for the “best” health care and most advanced technology and because Americans are unlikely to make the personal changes that will impact their long term health status. The fundamental question remains who or what organization is in the best position to control costs? And, do we want the answer to be in part, that we simply refuse to pay for certain treatments or artificially lower payments to the point we affect the delivery of care?

We are hearing a lot these days about “affordable” health care, yet I am not sure there is agreement on just what that means or how to achieve it. Is it 2% of income, or 8% or 10%? Does affordable health care mean lower premiums or lower out of pocket costs or both? Americans don’t like to spend their money on health care, just try raising a co-payment by $5.00 and you will know what I mean. How do we change that mentality and put $100 spent on health care on par with the same amount spent on a six new CDs?

How do we get to this illusive “affordable” status after we know what it is? Frankly, I am not sure, but I am sure that you don’t get there by waiving a magic law telling insurance companies not to charge so much or by shifting costs somewhere else only to rebound in a few years. The fact remains that the vast portion of premium is driven by claims. If insurance premiums were truly the problem, then the 79 million Americans covered by employer-based self-insured plans should not have trouble controlling costs and neither should Medicare. Assuring that all Americans have health insurance may spread the cost more equitably for those of us who today are paying for coverage, but it does nothing to lower or slow the rate of increase and in fact may escalate it.

While I eschew the word mandate, I see no way to avoid it in some manner when it comes to health care. So, unless we sincerely believe that government can do it better, every employer in the US must offer a minimum level of health coverage (defined at the federal level), and must pay a reasonable portion of the premium. Many will argue that employers cannot afford such a requirement. I would argue they cannot afford to be without it. All employers are going to pay for health care, either via premiums or taxes, so the question is how much control do you want over those costs? That is true even if your competitors are overseas, costs are costs. State insurance laws must permit alliances of companies to buy coverage, and must avoid expensive mandates. Tax laws must change to give equal value to all Americans regardless of their source of coverage. The unemployed and poor must have access to pooled coverage uniform among the states and subsidized as necessary.

No matter where you stand on the health care issue, one point is quite clear, we need to focus on the real problems, avoid rhetoric that has no substance and hold a long term view on the implication of the solution we embrace.

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Quinnscommentary.com

In this subject, as with most others, people fail to differentiate between our differing Government bodies. We are not one people SOLELY under the Federal Government. The Federal Government is a LAST resort government when it comes to our day-to-day lives. It has very few, very limited powers granted to it by the People, through the Constitution. Health Care is NOT one of those powers, so discussion of ANY Government involvement in Health Care should exclude them.

I think all forms of Welfare ought to be handled at the Local level, where each individual who pays taxes will be financing the costs of people they know, people they work with, people they can hold accountable with a reasonable belief that their voice will matter.

If my County financed my neighbor's Health Insurance through MY taxes, I'd know where to go to complain that he's fully capable of working his yard, but still receives benefits as if he couldn't work. I'd know where to go to complain that another neighbor doesn't seem to be getting decent care. I'd be able to hold accountable those people who wanted to live off of my labor.

Social Security is overwhelming proof that the Federal Government is 100% INCAPABLE of effectively managing OUR money. The fund(s) used to try to dole out Health Care would inevitable become sources of revenue for anything and everything BUT Health Care. Health Care, like Retirement, is based on the idea of saving now for sometime in the future. Government spends NOW and tries to figure out how to pay later. Those two ideas are incompatible.

Handling Health Care on a Local level would not only create accountability, both from the taxpayers and from the people in charge of handling the money, but it would create competition. If the next city or county over had far better Health Care, it would be easy enough to move there. When the city whose health care sucked suddenly noticed an exodus and loss of tax revenue, they'd have little choice but to change their plan or close up shop. Since there would be much more intimate accountability, however, it would rarely become that extreme.

Initially, there would be difficulty, of course; there'd be new scams for old cons, there'd be new problems for incompetent leaders, there'd be new grumbling from people who'll grumble about everything...and that's probably why it'll never happen. Nobody these days is willing to sacrifice a moment's convenience for a lifetime's satisfaction. As long as the Federal Government can tax you to death gradually, American's seem more than willing to bend over. As long as Americans don't feel the impact TODAY, they could care less that their grandchildren will be faced with an unfunded Health Care system that's falling apart and is worse than what we're trying to prevent today...again, just like Social Security. How many senior citizens are actually Secure because of Social Security? One? I doubt it.

Above and beyond all that - how much freedom is Health Care worth? You can be 100% certain that with Government financing comes Government interference. You trust Uncle Sam to decide what's best for your health? You trust Uncle Sam to sit quietly paying for our Health Care when it knows it could regulate our diet and reduce costs? You can depend on cost-cutting...but not in any beneficial way. The more costs they cut, without lowering taxes, the more money they leave for themselves to spend wherever they want. So, yeah....the Federal Government will be HIGHLY motivate to reduce THEIR costs, at our expense. As usual.

If there's any doubt about that, we have two centuries worth of Congressional spending records to prove it. And in those two centuries, Americans have voluntarily become more and more ignorant and blind to where their money goes. They will gladly drop $100/week off their debts in exchange for $2000/year in taxes, without ever doing the math, because their paycheck is NOW and taxes are LATER.

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Global Warming is my favorite color.

Can anyone give a logical explanation as to why the Bush Administration went to such great lengths in terms of military lives lost (4000+) and innocent citizens killed nearly 1,000,000), to lie us into a war over approximately 3,000 fatalities on 9/11, but shows absolutely no concern that we are losing between 80,000 and 100,000 people EVERY YEAR from MEDICAL MISTAKES?