Health Care and Society – part 2

Themon,

Wow. You cover a lot of ground. First, I might be interested in viewing that clan article you mentioned. I have a few theories on the proper or desirable roles of clans and families of my own. However, it is entirely theoretical, as society is no longer tied to any unit larger than the nuclear family, and even then only so long as children are home. For good or ill, that is the context in which we consider how best to fund and manage health care.

Now then, I will address one tangential point: your contention that the American Dream itself destroys families. This is simply not true. The American Dream, the belief that anyone can better his condition with hard work and effort, has indeed been an inspiration to people all over the world for the last 200 years. For all but the last 50 or so of those years, though, American families were strong and cohesive. How do you explain that? Many factors have gone into the destruction of the American family and the rise of a disposable consumer society. The feminist movement, the advent of modern transportation, and the constant wealth destruction of the Fed (which is the true source of the rat race you mention) are just a few factors that leap to mind. However, the idea that Americans are entitled to the fruits of their own production, and that if they produce enough of value that there is no limit to what they may achieve, is a source of hope for families. Have we been struggling for the American Dream as our families have fallen apart? Yes, but correlation is not causation. You could say that constantly seeking to improve technology has destroyed our families with equal validity.

Okay, so I know that is all a minor point in this discussion, but it disturbed me enough that I could not just pass over it. Now then, on to the crux of the matter: What should we do about healthcare?

My first instinct is always to rely on the free market. The Ludwig von Mises Institute has a few ideas on this matter, and I am sending a compilation of them onto you. They might even be very good. I haven’t read them (or at least not all of them) because I see a fundamental problem: I do not believe the medical field can ever be a truly free market system.

My family has quite a few members in the medical field as physicians, nurses, dosimetrists, dentists, clinical researchers, et cetera. Almost all of them are avid free market advocates, but they all acknowledge that the people of this country will never be comfortable looking at an uninsured trauma victim, who also lacks cash on hand or any charitable sponsor, and chucking them into the nearest gutter to bleed to death. Charitable institutions will also never adequately pay for all the non-payers. I agree with all of this. Therefore, much as it irks me, some form of governmental intervention is indeed necessary. But what form should it take?

While I am unwilling to chuck people into the gutter just because they are uninsured, I also do not think that everyone with narcolepsy should have access to the very latest, most effective, and most expensive form of medication whether or not they are uninsured. I do not think we need to keep people on life support in the ICU just because their uninsured families refuse to accept that there is no chance of recovery (you would be appalled to find out what a large portion of hospital budgets are flushed away by just such infuriating situations). Thus, before we bring in the government, I think we first need to precisely define the problems we are trying to solve.

As I look around now, I see very little agreement as to what the real problems in healthcare actually are. I also see many ridiculous myths popping up with annoying frequency in nearly all the policy debates on this issue. In my last blog post (sadly quite a while ago) I linked an article which amusingly eviscerates many of these myths. I strongly suggest you take a look at Dr. Clifford S. Asness’ article, “Health Care Mythology.” You will note that it directly addresses many of your concerns, especially your citation of other socialized governments and tax systems. As he makes the same arguments I have made for years, but manages to employ more humor than my own cynicism will allow on the subject, I like his arguments better and will not belabor them again myself.

To me, the problem with health care is that true costs are difficult to define under all the layers of insurance and Medicare/Medicaid regulations, as well as the refusal on the part of Medicare and Medicaid to pay anything close to actual value. That needs to be streamlined. Further, too much of insurance is tied to employment, making portability an issue. In addition, absent an employee plan it is almost impossible to obtain insurance if one has a preexisting major health issue such as diabetes, cancer, AIDS, et cetera. Private insurance rates also seem to fluctuate at alarming rates to levels which make it difficult to maintain. Finally, there are far too many entirely uninsured people. All of this needs to change.

So, with the problem defined, enough to at least chat about, the next question is how should government address this? Personally, I don’t see much justification for the federal government to address this at all. The ability to make a complete overhaul of our healthcare system is not granted by any of the enumerated powers in the U.S. Constitution. Congress has not bothered to address this little problem, but I imagine they would attempt to justify it through an extremely tortured reading of the Interstate Commerce Clause. The Supreme Court might even buy the argument. I, however, would leave the bulk of the issue to the states under the 10th Amendment. However, the Federal government could certainly help by reforming Medicare and Medicaid—if only they had the money to pay for it.

The states have the advantage of being able to experiment with a variety of options, emulate one another when they see workable solutions, and make adjustments as necessary to improve. I do not see this as inherently more expensive. Indeed, I see these experimental and competing systems as far less expensive than the monstrosity Congress is contemplating imposing upon our nation in totality.

In our state, the Blue Ribbon Commission on Healthcare Reform put out several interesting proposals. They are all still on-line if you care to review them. My own preference was for the 5th Plan. It addressed the uninsured problem by requiring insurance for all individuals and imposing penalties for being uninsured. It offered subsidies for basic plan purchase up to several hundred percent beyond the poverty line. It did not impose employer mandates, which would hurt business, but did offer access to purchase pools and other co-ops as well as easing the issue of portability. It also imposed reviews of rate hikes and mandated that no individual could be refused for preexisting conditions. Of all the plans offered, I thought this went the furthest to addressing the major problems while preserving, as much as possible, the competitive market. It is expensive, though, and I would probably reduce many of the programs and basic coverage levels. Even so, paying for it would be difficult. Nonetheless, it is the best option I have seen here in CO.

On the Federal level, the options currently being debated are utter garbage. Ted Kennedy and Hillary Clinton both had frightening proposals, and yet both were better crafted than the current abominations our president is touting so heavily. The last I read of the bill in the House, the single payer system would inevitably eat up all private insurance (yes, you could keep your private insurance, but if you ever tried to change it you were forced onto the public system). Its mandates and penalties on employers, demanding coverage rarely seen today, would serve only to cripple business. Further, massive invasions of privacy (combining financial/bank and medical records to be accessed by a government database), exemptions from judicial review, wage controls upon medical professionals, politically imposed rationing, and much much more all went into making this bill more horrifying than I could have imagined. Even England doesn’t have quite so oppressive a system. I know Mr. Obama has been trying to tell people this isn’t really in the bill, but I have read it and it was all there. I don’t think he has actually looked at it. Or perhaps he is just lying, but I know a politician would never do that.

Even if these foul little items were removed, however, there is still the massive cost to think about. The Congressional Budget Office has itself flatly contradicted Mr. Obama’s claims that the bill would reduce costs at all. In fact, the CBO estimates (usually quite conservatively) that the bill would actually increase the annual deficit by billions of dollars. Eh, but as long as the Fed is printing money like mad anyway, what’s a few billion more, right? So we have a dollar today that is worth less than five cents in 1913; who cares? Soon it will be two cents, and then I suppose we may really see what people think of our fiscal policy.

While I am all for healthcare reform, I hate the current proposals before Congress. They won’t work, we don’t want all that they would impose upon us, and we certainly cannot pay for them. I also don’t like the fact that these myths are still dominating the conversation. It prevents us from really discussing the issues honestly as a nation. There is a long way to go in discussion and education before Congress can get down to the business of good policy making. Until their proposals look a bit more like what I described, there is no chance that I would support them. Frighteningly, though, Congress and the Fed have indulged in financial mismanagement so egregiously for so long that any reform at all may be quite impossible for some time.

This is really long already, yet I feel like it is still cursory. Anyway, I hope it makes sense. It is my opinion alone. It is hardly pure libertarian, and it galls me to admit that, but I don’t see much of a way around it. Take good care.

Julian

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