25 July 2009

You Care, I Care, We All Care for Health Care

It seems to me that - as is so often the case on policy issues - the health care debate is now led by extremists.

One the one hand are the conservatives who oppose universal health care. They see this as expensive and as a way to subsidize the lives of people who are careless about their money, their health, and the treatment of their liver. They don't see health care as any more of a right than membership in a Country Club.

On the other hand are the liberals who see universal health care as proof of the goodness and modernity of a community. And they oppose the notion that wealth ought to translate into privilege when it comes to somethings as essential as health care.

Obama is obviously closer to the second group, and I think that he may be leading us down a path we cannot afford. Health care for him could be what Iraq was to Bush - a vague idea that proves unsustainable because of a failure to move beyond platitudes and hand waving to the point of designing something that won't collapse once it makes contact with the real world.

Health care ought to be a right. But that statement is not the end of a conversation. It is the start of one.

People regularly criticize the US for how much we spend on health care. In 2007, it was an estimated 17% of our total GDP and in a decade it could be 20%. These facts are cited as proof of the failure of our system. I am not so sure.

Once you've bought your house, your car, shoes and meals, where are you going to put your money? Why wouldn't an affluent country put an increasing percentage of additional income into purchasing more years of life with more life in those years? It is conceivable to me that we'll eventually spend 20% to 35% of our GDP on products and services that enhance our feeling of well being, strength and agility, and mental acuity. Spending more on health (and I'd include psychological health under this umbrella) seems to me a sign of progress.

And this gets to the root of the problem and the essential problem to solve in regards to health care. When I say that health care is a right, I am referring to a particular level of care. You deserve police protection but you do not deserve a personal body guard. (But if you are rich, you can hire a personal body guard.) You deserve health care but you do not deserve a hip replacement at 85 (but if you are rich ... well, you get the idea).

Everyone deserves health care. Some basic level of preventative care, anyway, and coverage for broken bones, disease, etc. It's not obvious to me that health care necessitated by bad life choices (obesity, drug and alcohol abuse for instance) are rights.

And as to where the money ought to come from to fund this? I think that it ought to come from two places. One, it ought to come from a tax on products like fast food, video games, TV and corn syrup that contribute to obesity. Two, it ought to come from a tax on the premium health care that only the wealthy can afford. Any product or service deemed too luxurious to be covered by universal health care (and that should include a variety of procedures and drugs) should be taxed as a luxury good and the money put into a pool to provide basic care. This will draw revenue from groups that can afford it and groups that drive up health care costs.

Making our current level of luxury health care universal is a vote for bankruptcy. To decide that a swath of the population doesn't deserve any health care in the most affluent country in the world is a vote for immorality. The first step is to define what we mean by universal health care, carefully - bounding that in ways that provides essential care without creating an unsustainable health plan.


Anonymous said...

Is there really anybody that doesn't get health care now? I believe if you walk into an emergency room, the law requires that you need to be seen and treated whether you can pay or not pay. I personally believe that this isn't so much about health care but about government control of the private sector.

Ron Davison said...

for the last few years, about 50% of bankruptcies in the US are because of medical expenses. That seems to suggest that the problem with coverage is real.

Lifehiker said...

People without health insurance can go to the emergency room and then just throw the bill away. But this is an extremely expensive form of health care that we end up footing the bill for. Don't take my word for it, though. Ask any ER doctor or nurse.

First, uninsured people without "emergency" conditions are clogging the ER's. They use the most expensive venue to deal with problems that could be handled easily by a PA in a local clinic. So,we end up paying the high cost of oversized ER's and ER staffs.

Second, uninsured people with significant medical conditions often wait to long to go to the ER, so that when they arrive their problem has progressed too far for simple treatment. We pay huge costs when they are admitted and require days or weeks of expensive care. They should be able to see a doctor when they first get sick, saving us money.

We need to get health care costs down, for all of us. Filling the ER's with non-emergency patients is no solution.

Anonymous said...

I agree that health costs need to be effectively managed and brought under control. In my readings to date, I haven't seen how these costs are going to be controlled except by cost savings. This is where I have a problem. I have yet to see in my life what the government has run effectively so I am concerned about the government seeking to takeover a large sector in the economy. I think if it was really about cost containment, it would be a lot quicker process through the halls of Congress because there are very few people that think the end solution is to "do nothing."

Time to go enjoy one of our beautiful days in Al Franken country!! Still unbelieveable.