THE BLOG

Debate the Solution, But Don't Deny the Problem

03/18/2010 05:12 am ET | Updated May 25, 2011

I am so very tired of arguing.

Many of you have been listening to the noise for the last year or so. Some of you have been watching the fight for a bit longer. And then there are those of us who've been slugging it out for years, or even decades.

It's not fun anymore.

That said, I've always enjoyed debate. I learn best when challenged, and I have become an "expert" on health care reform mostly because I've been forced to answer questions and challenges. Over time, however, the nature of the discussion has changed. Instead of intellectual inquiry posed as questions, I am faced with declarative statements disguised as queries. Fewer people want answers; they just want you to stop talking.

I loathe talking points. If I had my way, I would do away with them entirely. Yesterday I was on the radio, and a caller phoned in with a list of "questions." Each was posed as a, "Isn't it true that..." fact. When I asked for any clarification or provided data to counter the statement, the caller quickly moved onto the next point. No one learned anything. If you believed the assertions of the caller, I assume you felt vindicated; if you disagreed, I assume you felt frustrated.

I recognize I'm not going to convince all of you to become single-payer supporters through a post here. I've learned to live with that. We will disagree as to the best solutions. But can we at least agree that there is a problem?

The United States is the only country in its class that doesn't manage to get health care coverage to all of its citizens. Yes, I know that uninsured people can go to the emergency room for care. But you can't get a screening mammogram or colonoscopy there, you can't get your child a check-up, you can't have a follow up visit for asthma, or ADHD, or diabetes, or anything else. It's not the same thing. Stop saying it.

The United States does shockingly bad when it comes to quality. On nearly every metric you might use to measure such quality, the United States is often mediocre, and sometimes at the bottom. Yes, I know that life expectancy could be due to other things and is flawed. I also know that infant mortality is sometimes measured differently in other countries. But in all of them? And how do you explain away maternal mortality? Preventable years of life lost? Low immunization rates? The low number of physicians? Poor continuity of care? Difficulty accessing care? And pretty much any other metric you can come up with?

The United States' strength is on caring for high risk diseases. No, it isn't. The mortality rates for respiratory illnesses, heart attacks, strokes, and even cancer show that just as many, if not more, people die of those diseases in the United States as in other countries we'd compete against.

That's because more people are sicker in the United States. No, they're not. Some studies show that the prevalence of high cost diseases in the United States are often lower there than in other countries. Others show that they might be a bit more prevalent here, but really not that much. Either way, it doesn't account for the poor showing in outcomes.

People in the United States choose to do unhealthy things. Stop already. We smoke less than other countries do. We also drink less than they do. Yes, we have higher rates of overweight and obesity, but not nearly enough to account for the massive differences across the board in metrics of quality.

People in the United States are older and therefore sicker. Um... remember that low life expectancy thing? Actually the United States has the lowest proportion of elderly and the highest proportions of kids. So we should be cheaper and healthier. Sorry.

Doctors prefer the current system. No, they don't. Doctors from Canada are emigrating here to practice in the United States. No, they're not.

Everyone who's poor has Medicaid, so people without insurance are choosing not to have it. Do you know how poor you need to be in Alabama to get Medicaid? A couple making $3000 a year with two kids does not qualify. It's not much better in Louisiana, Texas, Arkansas, or West Virginia. They're not choosing to forego health insurance. There is no way they can afford it.

People are uninsured because they didn't do the right thing, they're not responsible, or they're lazy and shiftless. Please. Ten percent of the uninsured are children. Are they at fault? About 45% of the uninsured worked full time in 2008, and another 15% worked part-time. They're not lazy. Some more are college students, stay-at home parents, or disabled.

How much does this awesomeness cost? More than $7000 per person in the US, and 16% of our GDP. That's much more than any other country pays. Here it comes... but they pay much higher taxes in those other countries. I don't even know where to start with that one. How about... who cares? We're paying much more per person for health care. So who cares if it's in taxes or premiums or whatever. But even so - we already pay more per person in public funds for health care than pretty much any other country. Got that? We spend more per person FROM TAX DOLLARS than pretty much any other country does. The private spending is just gravy.

As I've argued before, I welcome a debate on how to fix the system. There are many other options, and they all have good and bad aspects. But, please, don't deny the problem exists. People's lives are at stake - literally.

Read more about health care policy and get your questions answered at Rational Arguments.