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Thursday, September 01, 2005

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sarah

Interesting piece. Thought provoking, no doubt. Universal health insurance? Not so sure about that. While few could successfully dispute that some segments of our population undoubtedly deserve health care regardless of their ability to pay, for me, the jury is out on whether or not it is a inalienable right for all at all times. Where do your rights end and personal responsibilities begin? A question with no easy answer, for sure. One area of which I am certain, I do not want any government agency responsible for any more of my care and well being (as well as that of others) than is necessary. The way that I see it, if the government controls my access to health care, then they not only control me, but my health care team, medical facilities, and research. Have other countries managed to maintain this balance successfully? Possibly, although I'm not convinced. Canada is frequently cited as an example (often as an exemplary example) of a health care system done right. Is the grass really greener on their side of the proverbial fence? From what I understand they certainly do provide basic care to all citizens, something the US does not. However, it is also my understanding that they do have a tiered system. Level A has to accept what the government provides and has no alternative. Level B is a little more savvy and can improve their chances of receiving good care by knowing the loopholes of the systems and figuring out ways to maneuver themselves to the front of the treatment line. Level C has resources that give them the ability to hop that fence and receive treatment elsewhere outside of their country, frequently in the US. Why would this matter, since they have such a fabulous medical system? Unfortunately, there are tremendous waits for this care. Three to six months to receive treatments for cancer, diagnostic scans, for example, or closer to a wait of a year to see some subspecialties is, apparently, not uncommon. (I wish I could site the sources for this information right here, because they are plentiful and I know I always like to check my sources. But, in the essence of time, I will have to let you conduct your own research.) I used to work as a nurse on a Pediatric Floor in a University hospital. We frequently had children admitted for various surgeries from Canada, which I found interesting. When the topic of health care would inevitably come up, an explanation similar to the above would be given in one fashion or another. It was eye opening and definitely made me begin to reevaluate my feelings towards how health care is distributed and received. It also demonstrates how their care resembles ours more closely than it first appears. I am not disputing numbers, and certainly many studies support the system Canada uses as being better all the way around. But numbers can be misleading (the cost of the management of their system, for example, is often disputed) and don't always tell the entire story. I am also not disputing the value of providing basic services to all, just the method of delivery. Is universal health care the panacea it is frequently claimed to be? Just some food for thought.

And for dessert-The dentist analogy is used often to describe the plight of the uninsured, and it is an excellent way to do that. But, what is the excuse for those with coverage who don't use it? There are many. They are just not as visible since when their situation gets dire, they can go to someone providing sedation dentisty, pay big bucks, and get all fixed up so that their negligence is never known. Obviously not an option for the very poor. But, considering how many people I have encountered that could go to the dentist, but by their own admission don't, for various reasons, I have to believe that not everyone would choose to go even if it were provided for them.

Finally, if anyone is still out there. About Moral Hazard. This is tough. Clearly, no one chooses to get a heart transplant for fun, or have hemodialysis performed just so he can use his insurance. But, I disagree that people only go to the doctor 'grudgingly' and 'because they are sick'. Perhaps I just have a really careless group of friends and associates, but I can't count the number of times that I hear about them taking their child (or themselves) to the doctor for little more than a sniffle "because, it's only a ten dollar copay", or, less frequently, to the ER on the weekend "because it's only a $50 copay" and more convenient to get their ears checked then than to wait it out and go to the office on Monday. I am certainly not advocating that people should not take their little muffins to the doctor when they are sick. My point is that I see many situations where people would be more scrutinizing of health care if they had to pay the cost of the office visit in its entirety. The researcher in the article sites a 1970's study that showed people indiscriminately chose against well and sick care as their copay/financial responsiblity for the care increased. This led to more health problems. Makes sense. However, it seems as if the HMO's that were so popular in the 1980's and 90's were supposed to keep people healthier by allowing them to have preventative care covered as well as sick care have not appeared to have done that. Did they keep people healthier? Have costs been contained? Again, two sides to every story. I am a huge advocate of spending accounts. There are flaws. I don't have an easy answer for the pooling of high risk consumers. I know that we scrutinize each health care decision made more carefully knowing that we are paying for every penny of it unless we have extraordinary expenses, which our insurance will then pick up the tab for. And we are a family with chronic health concerns, needing medications that are very costly, and we did reach that deductible this year due to some unexpected health issues. None of that has persuaded me that we should change our method of health care. It has made me thankful that we have a choice. What about the people that tryly have no choice due to no fault of their own? I think we as a society should continue to search for an answer. Who knows? Maybe government health care is the answer, I just haven't been convinced of that. All I have to do is think of the IRS, DMV, DOE, and I quickly am prompted to think of other solutions.

Scott

Very interesting reply, pal Sarah. Thanks for taking the time. I obviously disagree with you in many places, but you’ve given me much to think about.

Rather than go through your response in detail, I think I’ll just point out a very few things.

Mainly, I think it’s that we’re starting from a very different place, which means we’re bound to see things differently when looking at the big picture.

Look, are there going to be people who game the system? Of course. And we all know of CEOs who have sodomized their stockholders or, in the case of Enron, every innocent taxpayer in California. Does this mean all businessmen are crooks? Of course not. Should all businessmen therefore be tarred with the same brush? Of course not.

Are there people who cheat on welfare? Although I don’t know of any, I’m sure there are. But Reagan’s famous "welfare queen" was an outright lie (as well as a bit of the class warfare conservatives so deplore). And study after study has shown that the percentage of people who receive an inappropriate amount welfare is well under five percent—and that includes cases where the welfare agency themselves are to blame. Since maxing out on welfare means living below the poverty line, it’s hard to really believe that many individuals culpable.

Similarly, I don’t doubt for a moment that there are some people who’ll go to the doctor when it’s not necessary. But as the author of the article pointed out, he went to have a couple suspicious moles checked out, something he might not have done had he to pay one hundred percent of the costs. Was his visit necessary? It might have been a needless waste of a hundred dollars. Or it might have saved thousands.

We had a neighbor growing up, a complete hypochondriac when it came to her son. Took him to the doctor for every little sniffle, to the point where her doctor had almost lost patience. Until the time she insisted he be checked out because he’d tripped twice the day before. And it turned out her ten-year-old had a brain tumor. Waste of money? Who could have said until it was checked out?

As my boy Donny Osmond once sang, one bad apple don’t spoil the whole bunch, girl.

So. I guess it comes down to, where you and I disagree is on this:

I believe that access to decent health IS a basic, fundamental human right.

If there are people who need health care but cannot get it, that is a problem. For all of us. You know, as our president’s favorite philosopher once said, "Yo, homeslice, whatever you do for the least of my peeps, you’re doin’ that for me. A-ight?"

Medicare is not perfect. No one is saying it is. No one is saying it cannot be improved.
Medicaid is not perfect. No one is saying it is. No one is saying it cannot be improved.
Canada’s health care system is not perfect. No one is saying it is. No one is saying it cannot be improved.

But if perfection is your benchmark, then there’s absolutely no financial justification for sticking with our current system which, compared to those other three systems, looks like the stone age and yet, paradoxically, costs far, far more. We all pay more yet get less. How does that work?

And, as mentioned, we disagree as to the basic morality of the situation. The benchmark isn’t perfection. The benchmark is: can we improve things for the least of those amongst us. And a nice side benefit to doing so is, it’ll likely improve the lives of the rest of us too. It’s a win-win, really.

As for your DMV/IRS comparisons, that's the incontrovertible argument against the death penalty. But that's for another time. :)

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