June 28, 2005
Feeding Frenzy, part I
My apologies for the wait, my last week and weekend were swallowed whole by my company’s Annual Meeting (30+ hours in less than 3 full days) and an emergency appendectomy thoroughly enjoyed by my father (he’s fine, no need for well-wishing). So without further ado, here is part one of my argument for a “single-payer healthcare systemâ€.
This basis of my idea that we should have a single-payer system begins with the idea that everyone should have access to healthcare. I will stop short of calling healthcare a right, but I do believe that the United States and its citizens have a responsibility to provide for the care of all its citizens.
This may seem a little crazy, and some folks may ask where in the Constitution is it written that the government is charged with this duty. And it may not be. However, there are several services which we now take for granted that are provided by the government without expressed constitutional duty.
Education is the one I choose to make an example of. It goes relatively without question that if you live in these United States of America, you have the ability (again, I’ll stop short of using the word “rightâ€) to attend a public school nearly free of charge through graduation of high school. Education is a service paid for by the constituents of the school district, and you tend to have to really try to make yourself ineligible for this service (i.e. expulsion). In some states, if you are accepted, you can attend a state university with no tuition fees, and in all states (that I am aware of), the public universities are, at a minimum, discounted to the residents of that state.
This is a service provided primarily to children and adolescents, in order to help them become productive members of society. I hope we can agree that education is a key component in the success or failure of an individual. I believe the fact that we, as a people, have chosen to provide children, the citizens most in need of help and support, of this nation with said education (regardless of the current state of effectiveness, which is another discussion) speaks highly of us. However it certainly doesn’t set us apart from many of our peer nations who also provide this service (with better outcomes).
My point is this: we choose to help our children, our neighbor’s children and to some extent the children of all Americans get an education. They certainly cannot provide it themselves, and many of their parents would be unable to pay for private schools in the absence of public ones. I believe that Americans in need of healthcare fall into a similar situation, only in this case there is no “public school†option. Millions of Americans, millions of America’s children for that matter, are currently without the means to receive healthcare. We’ve taken steps to ensure our children receive an education, so they may have a successful life, but we have not taken steps to ensure Americans access to healthy life.
At this time I am not asking any of the readers to support a full blown government run and through taxes paid for healthcare system. I am simply asking that you agree with me on this:
It is unacceptable that there are Americans without access to healthcare, and we have a responsibility to do something about it.
T. F. Stern's Rantings linked with Free, Did You Say Free?
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Using the children as an example for universal healthcare was a bad choice. Every state has a Medicaid program and nearly all of them insure children under the age of 18 with next to no criteria for qualification. I have to disagree with you though that it should be available to all. Education isn’t a bad example of something not being in the Constitution but being provided by the government except that the government has failed at educating our children. Countries with single-payer systems have lower levels of care and increasing gaps between private pay countries when it comes to technology. Canada is a prime example of a single payer system and it’s failed in every regard. It is not the governments job to take care of us cradle to grave. It is not their job to hold our hands and walk us through life. The more responsibilities are taken on by the government for our daily lives, the less we are living and more we are merely existing. Healthcare is not a right or an obligation. I have lived without health insurance for a large chunk of my life and I still don’t expect Uncle Sam to foot the bill and take care of me. That’s my job, not his.
Hello
Every person in the US already has access to healthcare. If you get hurt or sick you go to the emergency room and get care from a doctor. You are not required to pay for this care. It is even better quality wise than the One Payer care in Canada or Great Britian. Plus you get it faster also.
You say there are millions of people that do not have health care. Prove it. Of the oft quoted number of 40 million how many do not have health care by choice? How many are healthy 20 somethings fresh out of school with their good new corporate job who feel they are healthy enough to not need health insurance? How many are independently wealthy and pay for the doctor out of their pocket? How many are truly poor and REFUSE to get on medicade or some other already existing government program? When you do the math you come down to somewhere between 3-5 million people who work in some way and can not afford some kind of health insurance. Not nearly the boogeyman that many people make it out to be. I am not saying that there is not a small problem here but it is not the situation that calls for universal health care. If you like going to the DMV then government run healthcare is for you. Plus when the government takes over what are you going to do for the tens of thousands of insurance company workers that you put out of a job? What about all of the senior citizens for whom insurance company stocks have been the staple of their income earning retirement portfolios? When you throw them on the street and knock the dog food out of their mouth what are you going to tell them?
If you would simply allow people to choose cafeteria style health care plans and get some of the regulation out of health care that requires plans to cover ingrown hair care and psycotherapy for your dog then the costs will come down. Why can’t I get a plan that covers major illnesses(cancer,etc.) and accidents(fell off the ladder)? Instead I get a plan that covers everything under the sun and then some. Somebody has to pay for all of that extra stuff. I wish it wasn’t me.
S
The education system in this country is in need of adjustment, but the fact that the government has failed (in many respects) to provide a quality education to many of its citizens does not release them from that obligation. That’s why education is such a popular topic around election time.
There are popular horror stories regarding wait times in Canada, but based on outcomes and life expectancy, their system is superior to ours. I don’t want to mirror Canada’s health plan anyway, more on that later.
As far as Medicaid for children goes, you must live in a pretty giving state. In Ohio, a family of four that makes over $36,000 a year better have insurance, otherwise they’ll be paying out of pocket for their kids hospital visits.
I also commend you for taking responsibility for yourself. I certainly don’t want the government to walk you through your entire life either. When it comes to fancy clothes, nice cars and big houses, you better earn it. However, I don’t want to live somewhere where people choose between going to the hospital when they need to and being able to make rent.
Jim,
Let me fire one question back at you. Before the federal government decided it was their job to run our educational system, how many people in this country weren’t getting educated? I.e., how did the system work before the government was involved, and how does the system work now?
I can pull out a piece of paper and write “Diploma” on it for every 18-year-old in the country– I’ve got the time. But that doesn’t mean I’ve educated them, does it?
As others have pointed out, not having health insurance doesn’t mean you don’t have health care. So a better (and less pointed) question for you to ask is whether we, as a nation, should be responsible for ensuring that everyone in this country has health insurance.
So when you ask us to agree that there are millions of Americans without “access to healthcare”, you need to clarify this statement before we move forward one bit.
Free, Did You Say Free?
…we have to pay for it regardless of the quality, at premium prices to boot
S: About 42.6 million Americans do not have health insurance, including 10 million children.
http://www.govspot.com/know/insurance.htm
There is my number.
Source: US Census.
You think all but 3-5 million of those choose not to be insured? Prove it.
Brad & S: Yes, anyone can walk into an ER and be treated. But the idea that you don’t have to pay is patently absurd. Those in the poorest groups often qualify for programs which allows them not to pay, but many more people will be hounded by hospitals and have their credit ruined before they are able to pay off their bill.
I guess my rephrased statement is, that nobody should have to worry about bankruptcy when considering their healthcare. Or better yet, it is a crime (my opinion) that getting sick puts so many people in the poor house. I’m choosing not to respond to the education crisis right now, as I don’t want to get side tracked.
TF: I never said free. The only time that word appears in my post is in reference to schools, and in the following text point out that it is paid for by the constiuency of the school district. Of course we would have to pay for it.
Jimmy, You are young and still learning. Most everyone in this counrty has some kind of access to health care. If you don’t have a health care plan you can go to the county health clinics or County hospital for care. You might have to wait for services but you can get care. It is not the governments place to provide health care to it’s citizens. The governmnent can barely take care of itself, what makes you think that it could run health care for the entire country. It’s done a miserable job with the school system and it would probably mess up health care too.
The private health care system could use an overhaul but it shouldn’t taken away completely. I am on an HMO and it is pretty close to what a government run system would be like. You could not choose your own doctor. You would have to get permission for every little treatment you have done. And I certainly would not want to be put on a waiting list for a Heart Bypass. We had a friend of ours that was put on a six month waiting list. She came to America and the doctor here said she would have been dead before then If she had not recieved immediate care. What happens to the old people who the government decides to string along until they die just so they don’t have to “Waste” any money on them? I don’t want a Government run system and I will fight tooth and nail to keep it privatized.
There is a new Consumer Driven Health Care System out there now that will help people who cannot get coverage any other way. Jimmy, do a little bit more study on this subject before you write part II. Thanks for you thoughts.
Okay, so we’ve established that you believe that catastrophic coverage should be a distributed cost.
To make sure we’re on the same page, how far further do you go? Are normal doctor visits covered? Allergy medication? Vaccinations?
Because the argument can easily go two different ways. I.e. if you state that all the stuff in the second group should be single-payer by the state, I have to think that we’re going to run into a rationing problem (i.e. that when something is “free” to the consumer, it is used unnecessarily, which drives up the price). If you only agree that the first group is necessary, obviously people don’t get cancer or get hit by buses “just because it’s free”.
I hate to hamstring these arguments on the front end as much as I am, but if we’re going to get anywhere, I think it needs to be done. Mainly, because the claim that catastrophic health care shouldn’t bankrupt somebody is a lot different than the claim that government should pay for you to go visit the doctor to get your Viagra prescription.
People could get a catastrophic policy for the big things and then use the new Consumer Driven Health Care plan for every day earaches, sore throats & etc. It would work!
Jim, two things to consider.
1. Education is not a right, it is a legal requirement. That is, no parent (or child) may legally choose that their children not attend school. That’s neither a right nor a privilege, that is a legal obligation. By the way, making school mandatory hasn’t improved the literacy rate, the literacy rate has actually declined since that happened. Something to think about.
2. No person in this country does not have access to healthcare. There is a difference between access to healthcare and the ability to pay for whatever healthcare you desire. And, if someone chooses to buy a television, a car, pay for cable, buy cigarettes, etc. instead of spending that money on healthcare is there some particular reason I should feel bad for them when they can simply go to an ER, get treated and then never pay?
I live in Kansas. This state does do a lot to take care of the kids, I’ll admit that. Your comment about a family of four in Ohio sounds like you want the entire family to be insured. If that’s the case, then I don’t think there’s a state out there that will insure a family making $36,000+ a yr. The kids could be though. There is NO reason for a child in this country to not have insurance unless the parents just havent applied for medicaid. And I don’t know what the cost of living where you are is, but $36,000 is is almost twice what I make each year and I have to pay all the bills that anybody else has to pay and I’ve managed to save quite a bit of money. $36,000 may not get you broadband cable access or a humidor full of Cubans, but it’s sufficient to support a family on if the adults budget well. The reason health insurance is so expensive is not due to the costs of medical treatment. In fact, the rising costs of treatment and the rising premiums for health insurance are due to the outrageous awards in various malpractice suits. A doctor in Topeka who has never been sued for malpractice has to pay more per month for malpractice insurance than I make in a year. How does he afford that? By increasing the costs passed on to the patients in his office. Get the malpractice premiums and awards down and the costs of medical treatment and insurance will start to drop.
Scott,
The question of how much malpractice has caused the price to increase is debateable. I think it’s a factor, but even eliminating it will be a drop in the bucket. I think the biggest problem that we have right now is that people treat health care differently from any other need. Since such a small percentage of people actually pay their own *premiums*, it’s not even like auto insurance where you see how your behavior can affect your premiums.
When health care costs you nothing, you use it more often than when it costs you out of your own pocket. The knowledge that over-use will raise your premiums means nothing to you if your employer is paying your premiums, not you. The fact that certain behaviors (smoking, eating unhealthy, not exercising, etc) can increase your risk doesn’t in any way increase your premium, so you have no link between your own unhealthy behavior and the cost of your care. And the thought that health insurance should cover everything from the sniffles and regular checkups to major catastrophes doesn’t help.
Compare that to auto insurance. You pay your auto insurance, so you know how tickets and crashes affect your premium. At the same time, certain other factors contribute to your “risk level”, which affects your premium. Not only that, but you don’t claim insurance when you need new tires, an oil change, a tuneup, etc. Thus, you make sure that you do what you can to keep your behavior and your relationship to your insurer set up to reduce the costs, and rely on insurance to pay for major things like having a car stolen or crashed.
But when you remove all semblances of a market from health insurance, you lose all manner of self-correction and efficiency that a market can produce. I tell you this, we talk about obesity being a major health care issue in this country. If people paid their insurance premiums out of pocket, and it was indexed to your BMI, you’d see a hell of a lot less fat people.
NEW AS OF 6-30. Apparently I misunderstood the changes in Ohio and overstated them. I acknowledge this error and have changed the comment to reflect the truth.
As of 7-1-2005:
In Ohio, for a family of four, the children are eligible for medicaid if the total family income is less than 200% of the poverty line which is approximately $36,000.
The parents are eligible if the total family income is less than 90% of the poverty level, that would be in the neighborhood of $17,000.
Jimmy, It’s still a matter of choice if you want to obtain Health Care for your family of four. As Eric stated above, some people would prefer to pay for cable TV, a new car, etc and not Health Care Services. The State is not responsible for each families Health care. The ones making decisions for the family have to make a choice as to what is important for that family. I have a friend whos husband had a bad heart, his company had no health care. She took a job at Walgreens, just so they could have Health coverage. She did not depend on the state to pay for his coverage. He was in the hospital countless times and finally died from his bad heart. She still works at Walgreens now to make a living, but the point is that that family made sure that they had Health Coverage. It’s a matter of priority!
Jim,
It sounds like the consensus here is that those in abject poverty are covered by government programs, and the commenters of this blog feel that those who are lower-middle-class could change their priorities to obtain coverage if they really valued it.
So for your statement, “It is unacceptable that there are Americans without access to healthcare, and we have a responsibility to do something about it”, it sounds like people are assuming that those people who are above the line where the government pay for health care could obtain insurance on their own.
Can you show that those people who do not have health insurance, and who are above the government cut-off point, cannot afford health insurance?
It is pretty clear that the majority of the readers either do not think there is a problem with healthcare coverage (the uninsured are just lazy and choosing plasma screens over health coverage) or just flat out don’t believe they have a resposibility to care.
I am now forced to show you what a joke of the “free market economy” the insurance industry has made. Perhaps I will have more luck when you realize how mcuh more money the insurance companies waste than say…the medicaid program.
I cannot believe what I am reading: you call yourself a libertarian and then advocate some horrible action like this? Where is there ANY authority for ANY government to force any of us to participate in a health program? Why should we give government any authority to do so? Your logic is flawed: it could apply equally to food, water, air, or even automobiles or jobs. You have every right to believe and advocate stuff like this, but don’t counterfeit a libertarian in doing so, please.
Nathan,
FYI, I (Brad) am the owner of the blog, and the one who calls myself a libertarian. Jim does not. The official position of this blog is the position that I offer, and as you can see in the comments, I don’t agree with Jim on this one.
Jim posts here not because I agree with him, but because I think he’ll offer an interesting viewpoint, and one that is frequently different than mine. And judging by the response he had to this post, I think that was true.
But the only posts that I would suggest judging by the libertarian credo should be the ones that I write. There are plenty of reasons to disagree with Jim on this one, but he’s not misrepresenting himself as a libertarian, because he’s never called himself one in the first place.