Thoughts on Healthcare

I am mostly in agreement with Danny’s post but I have a few other thoughts to add. First I would like to identify what I think are some facts about the state of America’s healthcare system that cannot largely be disputed no matter how you feel the problems we face should be solved. First, healthcare in America is too expensive and the rate of growth of prices outpaces inflation and shows no sign of slowing. Second, 50 million, and possibly more people don’t have health insurance to buffer them from the high cost of care. Third, there are cultural, economic, and social patterns in this country that will make it very difficult to reform healthcare and improve the level of public health in this country. One is Americans’ tendency to overconsume healthcare (moral hazard) and thus drive up its price. Another is our love affair with food and tendency to live sedentary lifestyles, which is why obesity afflicts approximately 23-25% of the population (some rates are higher in southern states). Subsequently Americans become susceptible to chronic diseases like heart disease, stroke, and cancers and thus must consume more healthcare than if they were healthier. Obesity is on the rise, especially in children, and thus it seems like chronic diseases may plague the next generation of Americans to the same if not a greater extent.

These are the sobering realities to face, and both Republicans and Democrats are trying to invent ways to deal with these problems, most notably to control costs and cover the uninsured. In short, the Republican model is to increase competition within the free market by creating interstate competition of private insurance agencies, increasing protection of doctors from frivolous lawsuits, rewarding doctors for good health results (to decrease their overuse of procedures), and place decision making power for healthcare in the hands of the patient. The democratic model is more focused on creating a single-payer healthcare system, perhaps similar to that of the UK in which all citizens are covered and in which the supply of healthcare is controlled by the government. While I largely agree with the Republican model, its biggest weakness is that this system does not guarantee coverage for every American. Prices could theoretically drop, but poor families or those with special circumstances could be left out of coverage. I am also critical of the democratic model because I do not think government should be given the power to make decisions about people’s health. As a future physician, I think this should be left first and foremost to the patient and also to the doctor. This model would also drive up every cititzen’s tax burden. Moreover, it would reduce the quality of care for people who are able to afford private insurance, complicate the patient-physician relationship, decrease compensation and motivation for doctors, and negatively impact people’s health (in the UK people cannot see specialists or undergo specialist procedures until they see their primary care physician first and are often placed on 6-12month wait lists for scans, procedures, and surgery).

One solution that is not as drastic as a single-payer system is to make public-funded healthcare optional and to have it subsidized by both the state and the government so the financial burden is spread across institutions. Also, allow people to keep their private insurance. Another option, which would be similar to the way Singapore runs their health system, is to create universal coverage but have the government only fund a certain percentage of healthcare. This way no one would be without insurance and people would still have to keep a job to healthcare would not become a welfare-like system. These are just some thoughts on how to increase coverage. Whatever intervention the government decides to put into law, whether it ends up being from the republican or democratic part, will not “solve” the healthcare crisis because while everyone will be covered, our system may become less efficient and lower in quality. Moreover, cultural, economic, and social mindsets of Americans will most likely persist and our health as a country may not improve. The problems with American healthcare are numerous, complex, and may not be solved by any sort of intervention, be it government funded or created by the free market.

Re: Axis of Evil Heats Up, Healthcare & More

Danalee said...

I really don't like that the government is involved in healthcare at all. Medicare and Medicaid are failing organizations and are very poorly managed. I worked in a pharmacy and most people would have both to even get what they needed covered. I don't even like HMOs, why should a company dictate what doctor I can see? Why should the government?
Insurance is bad enough we don't need the government making it even worse. And then they want to provide the healthcare? We can already go to the doctor whenever we want, get whatever procedure we want done, visit the emergency room, call and ambulance. No the government doesn't pay for it but if they did you wouldn't have the freedom to do it as you please. Look at the countries that already have socialized healthcare. It doesn't work. It won't be better.

Nice post, Pearce. I had just heard about North Korea but I didn't know Iran did anything until now.

Danny said...

Pearce, Great thoughtful blog post once again. Also did not know about the Iran issue. I agree that we need to start showing metal soon. Thought I think a lot of people are ignoring what I'm hoping will happen: using the Middle Eastern Arab countries + Israel on Iran. It's the most common feeling of fear Israel/Arabic countries have had in common. Alliances there would have greater effect than Obama's words or meaningless U.N. resolutions condemning Iran. 

On Health Care though I disagree. It's very complicated and I'm still only 75% sure I disagree but in short I'll try to explain: It's not that I do not have the same fears conservatives do of a public plan, it's my understanding of how horrible our health care system is today. Let's be honest that the left has realized this for long (see clinton) and the right has only come on board because it has become clear how horrible our health care system is. It's unsustainable cost-wise etc...I won't go into that. It is that the republican counterpart plan is a joke IMO. The tax credit proposed by the republicans (which I think was the same McCain proposed on the campaign trail that I opposed) is definitely not enough to cover high premiums available. They do not offer great concrete stuff on how to decrease costs. One of the most useless wastes in American health care is administrative costs (27% of our health care costs). This is because it takes so many resources to deal with the different insurances + figuring out who is/not insured. I do not remember the stats for other countries besides canada (18%) but we are the highest. My biggest fear of the public plan is the favorite conservative scare word: rationiong. Way I come to terms is that is the 50 mill we have uninsured now (& climbing w/ further job loss). The left is 100% correct when they say that is a form of rationing!!! That is also killing many people (+ helping kill our economy as it increases health care costs). Learning from mistakes Britain has made in rationing with a public system and figuring out how to do it best IMO is much more advantageous.

More reason to have less faith in the private system. As I said in the previous post, rationing is happening as we speak. It's called the uninsured...

http://www.slate.com/id/2218848/?from=rss

PG said...

Thanks as always for the comments. I certainly sympathize with Danalee's concerns about socialized medicine and, like her, look to other countries currently under the system to see its downfalls. Danny made a very interesting and important point when he said, "it's not that I do not have the same fears conservatives do of a public plan, it's my understanding of how horrible our health care system is today." As to this understanding, I defer to Danny as I have very little expertise on the health care system. It is very important to appropriately frame the policy choice against the status quo. If, as Danny suggest, the current system is worse than conservatives' worst fears about a socialized system, then the lesser of two evils becomes the best policy. I am not ready to concede that to be the case because I don't have a full understanding of the problems with the current system but am convinced of the major problems with socialized medicine. 

What I've come to realize with the health care debate is that where you stand depends on where you sit, sort of. More accurately than where you sit, it is where your focus and chief concern is. My point is this, if you have or most care about people who have satisfactory health care then you vigorously oppose socialized medicine for all of the reasons Danalee and the Wall Street Journal have articulated. If you can't afford or most care about people who can't afford health care under the current system then you may support any means to extend coverage universally, even through a single payer system, despite and regardless of what aggregate cost such a plan would have on the system as a whole, especially those who can now afford care. As with so many policy problems, where you stand depends on where you sit.

Re: Obama's Epiphany, Pelosi Steps In It & More

Andy said...

good stuff once again Pearce.

Blaine said...

Re: GITMO photos

idk pearce. i have a lot of mixed thoughts on the issue. i think that we need to be accountable for anything that we have done that violates human rights if we are holding other countries to the same standard. now, i do feel that the public should not have total access to the information that needs to be dug up, and that should include photos. you are right in the belief that it would endanger our troops.

Hunter said...

I wouldn't be so quick to commend Obama on his foreign policy stance, Pearce. His executive order to close Guantanamo Bay was clearly a political move, he's breaking lockstep with Bush only superficially. Obama's foreign policy is very much in line with his predecessor's; Obama's administration would still allow detainees to be tried in front of military tribunals and under his own proposed legislation, President Obama still has the power to order "Advanced Interrogation" techniques such as waterboarding (which, I might add, was only used a handful of times as a means of extracting information out of detainees at Gitmo.) The only difference is that those suspected of terrorism will be interrogated on American soil instead of Cuban soil. To me, it seems as though Obama is more pandering than making any meaningful revisions to foreign policy as it relates to terrorism. He condemns Guantanamo Bay but privately embraces the very principles and practices it employed that have drawn so much public criticism. I happen to believe that the use of these "Advanced Interrogation" techniques is a necessary evil in protecting American interests both at home and abroad, so I do not necessarily disagree with Obama's policy decisions. I do, however, think that it's worth pointing out that Obama's policies embody a "more of the same" approach, to whatever end, and do not in my mind warrant praise.

Elizabeth said...

I like that Pearce can recognize positive aspects of the Obama administration even though he bleeds red. I will read his blog because he can clearly see that the party he doesn't belong to isn't always completely wrong.

PG said...

Thanks so much for commenting y'all. I really appreciate that you took the time to do so. 

First, as to Elizabeth's comment, I have a hard time taking anybody seriously, on either side, who is a hard line partisan without exception. It's silly to think that one party is always right on every issue, so I appreciate your recognition of me trying to be more honest and open minded in my assessment of policy decisions. And yes, how ironic that I bleed two different colors depending on the playing field in question. 

Andy, you're awesome, thanks for the shout out; it means a lot. 

Blaine, I think you offer a very thoughtful assessment of the situation. I agree that, to the extent this admittedly imperfect country has done things in the past that run counter to our ideals and moral principles, we need to look at those actions and commit anew to living up to being the world leader militarily, economically and, as important, morally that we desire and profess to be. Now, whether or not the waterboarding of known terrorist fits into that category is a point of legitimate debate, and there are well meaning, good people on both sides. To the extent is is a case in which we need to make a correction, I agree with you completely that there is a way to do it "behind closed doors" that will accomplish the objective without involving a public that does not need to see all of the evidence and endangering our brave troops who are face to face with the terrorists right now as I exercise my freedom to blog my opinion, whatever it may be.

Hunter, I greatly appreciate your comment and specific assessment of the President's foreign policy. You are right on that his executive order to close Guantanamo was a rash and purely political/symbolic move (which Joe Biden essentially admitted recently... of course he did). It really is remarkable how much Obama's war policy has been "more of the same." I happen to believe that, certainly in the case of Iraq and Afghanistan, that is a good thing. On another note, his immigration policy is following in Bush's footsteps as well. I agree that many of his pronouncements have been pandering to the left, which, given the alternative that he actually follow through with them in policy, I can handle. The welcomed surprise was that he did a 180 on some of these pandering policy pronouncements, actually making decisions more along the lines of what I believe to be best for the nation. While ideally he would have understood the real threat this nation faces and the realities of war as a candidate and in the early days of his presidency, I praise him for seeing the light now rather than later and having the courage to essentially admit he was wrong (although I wish he would have a little more courage to actually say it) and change course. 

As Elizabeth observed, I like to acknowledge when the "other side" does something positive. It is intellectually dishonest and petty to disagree with someone simply for the sake of disagreeing or because of who they are. I prefer to give people the benefit of the doubt and try to see the best of intentions, although they can be hard to see at times. We get nowhere by setting up strawman arguments and caricatures of the other side. Washington and the nation at large will make progress when the two parties work together, when possible without sacrificing core principles, toward policy that will improve life, prosperity and security for all Americans.