Sicko Discussion: Many Nays, Few Yeas
I’ve been following the discussion surrounding universal health care and Sicko closely over the past couple of weeks. It’s interesting to me to see the polarity of opinion around the question of how best to deliver health care in this country.
One thing is sure: Reasonable, open discussion of the issues with solutions attached is nearly non-existent. Reactions range from “Universal Health Care will doom this country” to “Universal Health Care is the solution to all of our ills, physical and otherwise.” Where is the middle ground here? Is there a starting point? For me, there is.
Starting with a reasonable dialogue about how to limit the financial and political control that the three groups associated with the three prongs named above have on the reform process is a good place. Three of the most powerful lobbies in Congress are represented there. It seems to me that to have a reasonable dialogue about access to healthcare at a reasonable price, there needs to be a commitment (or revolt) that excludes any interest other than the national interest; that is, the citizens of this country and their need to receive healthcare at some sort of reasonable price. Michael Moore drives home how loudly the money talks. When he points out that there isn’t a single person in Congress who hasn’t received funding on some level from the companies with a vested interest in the status quo, I was tempted to throw my hands in the air and give up before even beginning. But I think we can make this work. The following links all came by way of Kevin, MD, who does a great job of linking yeas and nays alike, though he tends to lean away from the universal healthcare system proposed by Moore. (I’m not sure I’m sold on it either, at least not if the administrator is the federal government). Here are some of the ‘nays’ I’ve read in the past few days: Sicko uses omission, exaggeration and cinematic sleight of hand to make its points. In criticizing politicians, insurers and drug makers, it says little about the high quality of U.S. care. In lauding Canada, Great Britain, France and Cuba, it largely avoids mention of the long lines and high taxes that accompany most government-run systems. In fairness to the authors of this op-ed piece, they do make an effort to present a balanced view, but overall this quote states the premise of the author’s opinion. However, what they miss is that the quality of health care in the US isn’t relevant to people who have no access to it. This is the crux of the issue to me — we have to find a way to open the lines of access to healthcare and do it without bankrupting individuals or the country. WizBang writes:
The three-pronged profit pitchfork of our current healthcare system:
I do not believe that we have a health care crisis in the United States.
I do believe that we have a serious problem with the financial aspect of the health care industry.
I also believe that the biggest contributor to the health care financing crisis has been lawyers.
Personal injury lawyers like John Edwards, who can claim a large portion of the credit for crippling the obstetrics field in his home state.
The cost of health care has skyrocketed in the last few decades, while the actual income of physicians has not kept pace. In some cases, it’s declined tremendously. That means that a lot of money is going into the system is getting sucked out before it reaches those who actually provide the services. Some of it is leeched out by the personal injury lawyers, both directly (through lawsuits) and indirectly (through malpractice insurance premiums).
Some of it is sucked up by the tremendous bureaucracies instituted by the insurance companies, whose purpose is to minimize how much money gets through them to doctors and other health care providers.
Some of it goes into the increased overhead of doctors, who have to comply with zillions of regulations from health insurance companies and the government.
While I agree with some of what Wizbang writes, I disagree with the statement that we are not nearing a health care crisis in this country. We surely are heading in that direction. Less students are applying to medical schools. More doctors are leaving active practice for academics, consulting, and other areas of practice which relieve them of the need to pay exhorbitant malpractice premiums, expanding their payroll to include employees to manage the administrative red tape involved with insurance companies, and being paid less to do more. The students who do go to medical school are heading for specialty practices more often than not, leaving our family practices without general practitioners.
Yes, we are heading toward a crisis, Wizbang. But you’re right about the contributors to it, for sure.
On the other side of things, The Health Care Blog rightly points out that making a change is hardly as easy as snapping our fingers and making a new system:
A big problem I have with those who now advocate moving to a single-payer system is how really poorly thought-out their proposal is. Proponents seem to presume that you can get from Point A to Point B in one easy move.
The problem is that since 1965 those who operate in the the U.S. health care system have become something akin to drug addicts–they are addicted to all the incentives we have–good, bad, and perverse.
Both are excellent points. In the 1970’s a similar dialogue was taking place around pension and retirement security, and how best to reform the pension system in a way that was fair to employers and employees and would provide some measure of retirement security to all. Sen. John Erlenborn led the way to the passage of ERISA — a sweeping reform of how benefits were to be administered and delivered, how retirement assets were to be protected, and minimum requirements for the operation and administration of pension plans.
Despite Congress’ addiction to amending the pension laws every 2 years or so, the foundational spires of ERISA remain intact: No discrimination against employees; trust assets must be for the exclusive benefit of participants; vesting and benefit accruals must be earned over a limited number of years, and employees must receive annual disclosures and statements related to their benefits. There are other provisions, but these are the basics. By stripping retirement security down to the most basic level and starting there, a plan could be developed for implementation that actually delivered results.
We need to do the same thing with our current health care system. Take what we have, figure out the most basic requirements going forward, and then find a way to deliver those basics fairly and economically, which may mean forming some sort of foundation (non-profit) outside of the government but accountable to administer it.
There’s much more to be said. This is just the beginning. I’ll be posting updates with opinions pro and con as I have time. Or you can save me some and post a comment here to start things off.
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Stan
