Not quite balanced health care, part two
Category: Issue summaries
Posted on August 18, 2010 by Gary
My responses to the anti-universal health care arguments on this site, below the fold.
Okay, here we go:
Oh, there isn't? What about the fire department? Public libraries? Police? While police are out of control in a lot of cases, I don't think anybody considers them to be wastrels.
The author, in the extended entry, mentions Pentagon pork and the Department of Motor Vehicles as examples of government inefficiency. Problems with the former are typically the result of private contractors ripping off the government; the Bradley vehicle he mentions is manufactured not by the government directly, but by BAE Systems Land and Armaments. And having dealt with insurance company customer service, the DMV looks fairly good to me by comparison.
It's an article of faith among right-wingers that government is always inefficient. In reality, countries with government-paid universal health care spend far less than we do, while getting better outcomes. Even Medicare, despite the limitations of its current form, has a much lower overhead than private insurance.
Well, duh. Nobody, or at least nobody who knows what he or she is talking about, claimed that universal health care would be free. It would, however, cost us substantially less than what we're currently paying, while yielding better results.
First of all, there's relatively little competition in the insurance "industry." Markets are typically dominated by one or two large providers.
And profit motives do tend to lead to cost savings -- for the people making the profit. The individual ingenuity of the insurance companies enables them to find new ways to sign up healthy people while avoiding those at risk. Even more ingeniously, private insurers have come up with ways to drop subscribers on technicalities when they do end up costing more than expected. That's good for them, bad for the rest of us.
This is just wrong. Under the current system, patients with coverage are losing flexibility as they are forced into HMOs or other plans which restrict their choices -- sometimes with catastrophic results, as shown in the movie Sicko. And those without coverage, of course, have basically zero flexibility -- they're stuck with whoever will treat them for free. Under a universal plan, patients could go to any available doctor or other provider of their choice.
The health care industry is already dominated by special interests. They don't have to hide out in back rooms -- they work for their own special interests out in the open. They own the system. A public system couldn't possibly be more corrupt than what we have now. A single-payer universal system would end any restrictions on care that would require back-room deals. When everybody is entitled to all medically necessary care, there isn't anything to deal for.
I don't know about you, but for most people I know, getting medical treatment isn't high on the list of fun things to do. The idea that people, if liberated from onerous health care costs, will start going to providers for frivolous reasons is just silly. Certainly this doesn't happen with that dwindling minority of people who still have good health coverage.
Yes, if you are urgently in need of care, you can get care at the emergency room. And afterwards, you will be billed for this care, and when you find yourself unable to pay these bills then you can lose all of your life savings and other assets. So strangely enough, people are reluctant to do this.
Pure speculation. Doctor flexibility is already being reduced by the constraints of private insurance; before providing any sort of care beyond the routine, doctors must consider whether insurance will cover it or if not whether the patient can afford to pay for it. This already leads to poor patient care for everyone except those few lucky enough to have good health coverage.
Since "every man for himself" isn't a sustainable approach to financing health care in this modern world -- those persons unlucky enough to be in the ten percent which requires about three-fourths of the costs wouldn't be able to afford to pay for them -- any financing system will necessarily involve some sort of cost sharing where healthy individuals subsidize non-healthy ones.
Under the current system, this happens in a number of ways. Among people who buy insurance (or have it bought for them by employers), some remain healthy and end up not making any major claims, while others aren't so fortunate. Others have care provided through charity or by the government. Others get care and end up unable to pay for it, forcing the system to distribute the costs to those who can pay (see item 7 above).
Those persons who increase costs due to unhealthy activities such as smoking can, to some extent, be made to pay extra for it. Under the current system, this could take the form of higher taxes and/or insurance rates for those persons. This can, however, only be done to a limited extent before the ability of these persons to pay is exhausted. All of this is as true under the current system as it would be under a universal one.
Again, this is an issue no matter how we finance health care. If provider payment rates are too high, the system goes broke; if they are too low, people won't want to provide these services. A happy medium must be found, and a universal public system is well equipped to do this.
It's worth pointing out that under a public system, payments to doctors and other providers would likely be less, but those doctors are guaranteed to promptly receive those payments. Under the current system, doctors must employ specialists to work with insurance bureaucrats to get them to pay. When insurance won't pay, they need to bill patients, sometimes even employing third-party collection agents to try to force payment, and when patients ultimately can't pay then providers eat the costs.
As for research and development, the bulk of this is already financed by taxpayers, through tax breaks, patent protections, and direct subsidies. This will continue under universal health care; the difference is that the public will share in the benefits as well as the costs.
Yes, transitioning to a universal system will be painful. How long it will take is debatable, but there will be jobs lost in the so-called insurance industry as well as on the provider side as billing specialists become obsolete. That's in the short term. In the long run, a study by the California Nurses' Association shows that true universal health care would result in millions of new jobs. The alternative, doing nothing, means that jobs will continue to erode as employers, unable to afford health care costs, move operations overseas or just go out of business.
As an analogy, most of the treatment options for cancer are highly painful and debilitating, but that's not generally a good reason for leaving the cancer in place.
See item 10 above. By the way, most universal health care plans under consideration wouldn't eliminate private practice options. All they change is who is paying the bills. Meanwhile, under the current system, doctors are more and more being forced into investor-owned physician groups as private practices become unaffordable.
Real universal health care would actually reduce malpractice awards by a substantial factor. Currently such awards include money to provide for the victim's future care. Under a universal system this would be unnecessary.
Item 14, meet item 9 above. You two really should get to know each other.
This is another balance that any society must strike, between allowing personal liberty and protecting people from being taken advantage of. Currently, some things such as the use of heroin are banned because they are deemed, rightly or wrongly, to be health hazards. Others (tobacco, alcohol) are restricted and regulated. These are decisions that we can and must make as a society, whether or not we have universal health care.
After the Bush administration's wiretapping scandal, we know that not only are private corporations not inherently more trustworthy than the government, they will gladly turn over their databases to the government if it asks them to. On the other hand, if the public owns the database from the beginning, we can legislate the ways in which the government is and isn't allowed to use it.
We already have rationing of health services and equipment. Our health care is the most rationed in the world. But our rationing is based not on who needs care the most, as it would be in a sensible system, but on who can afford to pay.
Under a universal single-payer system, doctors and hospitals would not need pre-approval before providing care; that means that they, not the government, would make the decisions on who gets what.
While this danger is greatly exaggerated, it's true that you might need to wait a little longer to get care under a universal system. That's preferable to an ever-shrinking minority being able to get care quickly and the rest of the population not able to get it at all. Yes, you can shrink wait times by excluding a large portion of the public, but common human decency -- or if nothing else, the knowledge that we ourselves could end up as part of the excluded group -- should tell us that that isn't an acceptable solution.
Few things show how full of shit the right-wing is better than this sort of argument. According to them, government-provided universal health care would feature hellishly long waits, shoddy service, and bureaucrats abusing it at every opportunity to control our lives. But people will LOVE it so much that nobody will ever be able to repeal or alter it.
So yes, that's the problem with providing a stable, rational society for people to live in. They like it. They get used to it. They figure out that all of the right-wing scaremongering (see items 1 through 17) has no basis in reality. They don't want to go back to being serfs to big business just because right-wingers would rather spend the public's money on tax rebates for billionaires and on bombing countries half way around the world back to the stone age.
As a final exercise to the reader, take a function that's already provided to all and paid for by taxes. For example, fire-fighting. Go through the above list of supposed arguments against government-paid universal health care and see if they would apply to the service that the government is already paying for. Is the Fire Department a hotbed of corruption and sleaze? Do you need to wait six weeks and get approval from government bureaucrats before someone will come and put out your fire? And if the arguments are clearly hollow for that service, ask if there's any reason why they would make any more sense for health care.
Okay, here we go:
1. There isn't a single government agency or division that runs efficiently; do we really want an organization that developed the U.S. Tax Code handling something as complex as health care?
Oh, there isn't? What about the fire department? Public libraries? Police? While police are out of control in a lot of cases, I don't think anybody considers them to be wastrels.
The author, in the extended entry, mentions Pentagon pork and the Department of Motor Vehicles as examples of government inefficiency. Problems with the former are typically the result of private contractors ripping off the government; the Bradley vehicle he mentions is manufactured not by the government directly, but by BAE Systems Land and Armaments. And having dealt with insurance company customer service, the DMV looks fairly good to me by comparison.
It's an article of faith among right-wingers that government is always inefficient. In reality, countries with government-paid universal health care spend far less than we do, while getting better outcomes. Even Medicare, despite the limitations of its current form, has a much lower overhead than private insurance.
2. "Free" health care isn't really free since we must pay for it with taxes; expenses for health care would have to be paid for with higher taxes or spending cuts in other areas such as defense, education, etc.
Well, duh. Nobody, or at least nobody who knows what he or she is talking about, claimed that universal health care would be free. It would, however, cost us substantially less than what we're currently paying, while yielding better results.
3. Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness.
First of all, there's relatively little competition in the insurance "industry." Markets are typically dominated by one or two large providers.
And profit motives do tend to lead to cost savings -- for the people making the profit. The individual ingenuity of the insurance companies enables them to find new ways to sign up healthy people while avoiding those at risk. Even more ingeniously, private insurers have come up with ways to drop subscribers on technicalities when they do end up costing more than expected. That's good for them, bad for the rest of us.
4. Government-controlled health care would lead to a decrease in patient flexibility.
This is just wrong. Under the current system, patients with coverage are losing flexibility as they are forced into HMOs or other plans which restrict their choices -- sometimes with catastrophic results, as shown in the movie Sicko. And those without coverage, of course, have basically zero flexibility -- they're stuck with whoever will treat them for free. Under a universal plan, patients could go to any available doctor or other provider of their choice.
5. The health-care industry likely will become infused with the same kind of corruption, back-room dealing, and special-interest-dominated sleeze that is already prevalent in other areas of government.
The health care industry is already dominated by special interests. They don't have to hide out in back rooms -- they work for their own special interests out in the open. They own the system. A public system couldn't possibly be more corrupt than what we have now. A single-payer universal system would end any restrictions on care that would require back-room deals. When everybody is entitled to all medically necessary care, there isn't anything to deal for.
6. Patients aren't likely to curb their drug costs and doctor visits if health care is free; thus, total costs will be several times what they are now.
I don't know about you, but for most people I know, getting medical treatment isn't high on the list of fun things to do. The idea that people, if liberated from onerous health care costs, will start going to providers for frivolous reasons is just silly. Certainly this doesn't happen with that dwindling minority of people who still have good health coverage.
7. Just because Americans are uninsured doesn't mean they can't receive health care; nonprofits and government-run hospitals provide services to those who don't have insurance, and it is illegal to refuse emergency medical service because of a lack of insurance.
Yes, if you are urgently in need of care, you can get care at the emergency room. And afterwards, you will be billed for this care, and when you find yourself unable to pay these bills then you can lose all of your life savings and other assets. So strangely enough, people are reluctant to do this.
8. Government-mandated procedures will likely reduce doctor flexibility and lead to poor patient care.
Pure speculation. Doctor flexibility is already being reduced by the constraints of private insurance; before providing any sort of care beyond the routine, doctors must consider whether insurance will cover it or if not whether the patient can afford to pay for it. This already leads to poor patient care for everyone except those few lucky enough to have good health coverage.
9. Healthy people who take care of themselves will have to pay for the burden of those who smoke, are obese, etc.
Since "every man for himself" isn't a sustainable approach to financing health care in this modern world -- those persons unlucky enough to be in the ten percent which requires about three-fourths of the costs wouldn't be able to afford to pay for them -- any financing system will necessarily involve some sort of cost sharing where healthy individuals subsidize non-healthy ones.
Under the current system, this happens in a number of ways. Among people who buy insurance (or have it bought for them by employers), some remain healthy and end up not making any major claims, while others aren't so fortunate. Others have care provided through charity or by the government. Others get care and end up unable to pay for it, forcing the system to distribute the costs to those who can pay (see item 7 above).
Those persons who increase costs due to unhealthy activities such as smoking can, to some extent, be made to pay extra for it. Under the current system, this could take the form of higher taxes and/or insurance rates for those persons. This can, however, only be done to a limited extent before the ability of these persons to pay is exhausted. All of this is as true under the current system as it would be under a universal one.
10. In an effort to cut costs, price & salary controls on drugs, medical equipment, and medical services are likely to be put in place, meaning there is less incentive to pursue medical-related research, development, and investment, nor pursue medical careers in general.
Again, this is an issue no matter how we finance health care. If provider payment rates are too high, the system goes broke; if they are too low, people won't want to provide these services. A happy medium must be found, and a universal public system is well equipped to do this.
It's worth pointing out that under a public system, payments to doctors and other providers would likely be less, but those doctors are guaranteed to promptly receive those payments. Under the current system, doctors must employ specialists to work with insurance bureaucrats to get them to pay. When insurance won't pay, they need to bill patients, sometimes even employing third-party collection agents to try to force payment, and when patients ultimately can't pay then providers eat the costs.
As for research and development, the bulk of this is already financed by taxpayers, through tax breaks, patent protections, and direct subsidies. This will continue under universal health care; the difference is that the public will share in the benefits as well as the costs.
11. A long, painful transition will have to take place involving lost insurance industry jobs, business closures, and new patient record creation.
Yes, transitioning to a universal system will be painful. How long it will take is debatable, but there will be jobs lost in the so-called insurance industry as well as on the provider side as billing specialists become obsolete. That's in the short term. In the long run, a study by the California Nurses' Association shows that true universal health care would result in millions of new jobs. The alternative, doing nothing, means that jobs will continue to erode as employers, unable to afford health care costs, move operations overseas or just go out of business.
As an analogy, most of the treatment options for cancer are highly painful and debilitating, but that's not generally a good reason for leaving the cancer in place.
12. Loss of private practice options and possible reduced pay may dissuade many would-be doctors from pursuing the profession.
See item 10 above. By the way, most universal health care plans under consideration wouldn't eliminate private practice options. All they change is who is paying the bills. Meanwhile, under the current system, doctors are more and more being forced into investor-owned physician groups as private practices become unaffordable.
13. Malpractice lawsuit costs, which are already sky-high, could further explode since universal care may expose the government to legal liability, and the possibility to sue someone with deep pockets usually invites more lawsuits.
Real universal health care would actually reduce malpractice awards by a substantial factor. Currently such awards include money to provide for the victim's future care. Under a universal system this would be unnecessary.
14. Government is more likely to pass additional restrictions or increase taxes on smoking, fast food, etc., leading to a further loss of personal freedoms.
Item 14, meet item 9 above. You two really should get to know each other.
This is another balance that any society must strike, between allowing personal liberty and protecting people from being taken advantage of. Currently, some things such as the use of heroin are banned because they are deemed, rightly or wrongly, to be health hazards. Others (tobacco, alcohol) are restricted and regulated. These are decisions that we can and must make as a society, whether or not we have universal health care.
15. Patient confidentiality is likely to be compromised since centralized health information will likely be maintained by the government.
After the Bush administration's wiretapping scandal, we know that not only are private corporations not inherently more trustworthy than the government, they will gladly turn over their databases to the government if it asks them to. On the other hand, if the public owns the database from the beginning, we can legislate the ways in which the government is and isn't allowed to use it.
16. Health care equipment, drugs, and services may end up being rationed by the government. In other words, politics, lifestyle of patients, and philosophical differences of those in power, could determine who gets what.
We already have rationing of health services and equipment. Our health care is the most rationed in the world. But our rationing is based not on who needs care the most, as it would be in a sensible system, but on who can afford to pay.
Under a universal single-payer system, doctors and hospitals would not need pre-approval before providing care; that means that they, not the government, would make the decisions on who gets what.
17. Patients may be subjected to extremely long waits for treatment.
While this danger is greatly exaggerated, it's true that you might need to wait a little longer to get care under a universal system. That's preferable to an ever-shrinking minority being able to get care quickly and the rest of the population not able to get it at all. Yes, you can shrink wait times by excluding a large portion of the public, but common human decency -- or if nothing else, the knowledge that we ourselves could end up as part of the excluded group -- should tell us that that isn't an acceptable solution.
18. Like social security, any government benefit eventually is taken as a "right" by the public, meaning that it's politically near impossible to remove or curtail it later on when costs get out of control.
Few things show how full of shit the right-wing is better than this sort of argument. According to them, government-provided universal health care would feature hellishly long waits, shoddy service, and bureaucrats abusing it at every opportunity to control our lives. But people will LOVE it so much that nobody will ever be able to repeal or alter it.
So yes, that's the problem with providing a stable, rational society for people to live in. They like it. They get used to it. They figure out that all of the right-wing scaremongering (see items 1 through 17) has no basis in reality. They don't want to go back to being serfs to big business just because right-wingers would rather spend the public's money on tax rebates for billionaires and on bombing countries half way around the world back to the stone age.
As a final exercise to the reader, take a function that's already provided to all and paid for by taxes. For example, fire-fighting. Go through the above list of supposed arguments against government-paid universal health care and see if they would apply to the service that the government is already paying for. Is the Fire Department a hotbed of corruption and sleaze? Do you need to wait six weeks and get approval from government bureaucrats before someone will come and put out your fire? And if the arguments are clearly hollow for that service, ask if there's any reason why they would make any more sense for health care.
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