Pathetically but predictably, the health care reform debate is not focused on health care or reform, but rather on imagery meant to trigger our reptilian responses. In another article, I shall address what the "debate" should really be about (hint: improved health!), but in the public interest, in the hopes of lassoing crocodile frenzy before it totally consumes its young, I offer help for those struggling with friends and family who may be shaken by what has occurred during our own August recess.
This is not to suggest that those who already believe that health reform is designed to kill Granny, or that the government just wants to "take over" Medicare are salvageable. Rather, that there may be increasing numbers of people who do not buy the inflammatory rhetoric, but do not know how to respond (to themselves) otherwise.
Here's a little primer on addressing some of the most absurd claims:
1.The government -- i.e., not private enterprise -- wants to kill Granny. Let us get this straight. The government wants to kill Granny and, by implied contrast, private enterprise, that we all learned in Economics 101 exist for the sole purpose of caring for each and every citizen, will look out for Granny's well-being.
Is this the same private enterprise that sells death (cigarettes), needing to addict 15,000 new children per month just to maintain revenues? Or, is it the same private enterprise that resisted selling safe cars? Or, perhaps it is the same private enterprise that would never pollute our air or water, or, if they did, rush to clean it up before they hurt anyone? Or, maybe they mean the private enterprise that imported toxic toys for children? Or, the private enterprise that so generously donates candy and soda pop machines to public schools?
We actually do know the private enterprise they mean -- it is the private insurers who try not to insure people who are or may get sick, try to drop them from their rolls when they do, and deny every claim they can when they cannot drop you from their policies. That's the private enterprise that has been caring for you for years.
And what about the government? Perhaps the evil government they refer to is the one that determined cigarette smoking caused lung cancer in the first place; or the one that established pollution controls and standards for clean air and clean water; or, perhaps it is the evil government, out to kill Granny, that administers Medicare with less than a 5 percent administrative cost compared to 25-30 percent for private enterprise; or, the evil people at the Food and Drug Administration that ensure the integrity of the food supply and the safety (and potency) of drugs people take to combat illness?
Let us concede, however, that the government does deliberately kill people. It is called the death penalty. And, although the goal is not to have our own people killed, war usually does a pretty good job of ensuring people die. So, if Granny refrains from committing a capital offense, and does not -- like the Limbaughs and O'Reillys and Bushes and Cheneys and Kristols and Lowrys and Buchanans and Chamblisses who love war so long as they do not get called to fight it -- volunteer for the armed forces, it is not the government she needs to fear for her life.
2.We cannot afford it. Here's a shocker--we are affording it today, paying for it now. Hospitals, doctors, pharmaceutical companies are not giving away treatment and medicine for free. They are not printing their own money (although the word "scrip" is indeed in prescription). They are getting paid.
Now, how can that be? Well, if you are among the 260 million Americans who have health insurance, you are already paying for the 47 million who do not. Health care providers overcharge you assuming a predictable percentage of bills will go uncollected. You see, along with your insurance exec's Gulfstream, you pay for the uninsured with your premiums for those higher charges.
But, you don't mind, do you? Because they never called it a "tax."
If we get universal coverage, there will be no unpaid charges. Charges per item or service could come down and, therefore, insurance premiums could come down -- unless of course the insurance execs wants a company yacht along with the Gulfstream, or just to report higher profits, then they won't. Wonder what a competing public option would do? Hmmm....
And, by the way, there are huge savings to be had just from improved efficiencies of a system in which total costs count more than the cost of one procedure or drug or intervention.
The secret reason they never called part of your premiums a "tax" is that if we ever got health care reform, and premiums declined, or at least did not increase more rapidly than other parts of the economy, then we might have called it a "tax cut." And one of the "Old Rules" is the only the right wing gets to say the word, "tax cut." (Are you listening, Bill Maher?).
But, they are correct that health care costs are spinning out of control and that one of the purposes of reforming the system is to reduce those costs. One of the best ways of reducing costs is improving outcomes. More on that in another article.
3.Let private competition solve everything: Imagining a world without Medicare
Ok, to test that hypothesis, let us examine what our world would be like without Medicare. One possibility would be that the elderly would be insured privately and randomly in the same plans as the rest of us. Care to guess how high your premiums would be if your plan carried those higher risk seniors?
Or, suppose no insurance company really wanted to insure the elderly and they were without insurance. Then Granny gets sick. Who pays? Do you let Granny go untreated? Does Granny "allow" you go bankrupt, and deprive your kids, her grandchildren(!), of their college funds, to pay for her care?
Or, suppose there are insurance companies only covering the elderly? Their insurance premiums would be ... oh, doesn't seem to work does it? Very few would be covered since it would be unaffordable, so we are back to no coverage.
How about this? Your children can be covered to the age of 18 under your policy. What about your parents getting covered under your policy once they hit 65? Think we are back to sky-high premiums with that one.
I know, I know, I know (says Newtie), let's give each Medicare recipient a lump sum, and let them go out and buy private insurance with it. For starters, about 20-30 percent of that is no longer going into actual care, but into "administrative" costs, so their coverage would decline.. Then again, if a person is ill, the insurer may not wish to cover him; if there were a law against such discrimination, we are back to both skyhigh premiums few could afford and the contribution coming from Medicare being insufficient.
Now, for the most likely scenario without Medicare. Granny is covered, premiums are higher but not outrageously. Why? Because when Granny does get ill, the insurance companies will deny coverage, or drop her. So, you can have the wonderful experience of paying higher premiums and then going bankrupt a bit sooner, all while Granny is wondering how she could allow herself to do this to you, and her grandchildren. Now that would really kill her.
4.The free market can solve everything, and at lower cost. No, it cannot. First, and most convincingly, it has not. Since most systems tend toward equilibrium, it might have been surmised that, after all these years, everything would have already been solved. The purists would say that there are government programs around (like Medicare) that have distorted the system so that free markets cannot reach an equilibrium solution. But, that is nonsense. See # 3 above.
Secondly, though, free markets are genetically incapable of providing high-quality, low-cost, health care for all. Why? Because most people incur most of their health care costs when they are old. By the time they are old, health care prices have risen (even if at a normal rate), whereas their incomes were earned way-back-when wages and salaries were not nearly as high. Hence, even if they had saved prudently for the inevitable rainy day, it is unlikely most people would have enough saved from wages during their youth and middle age to cover the costs that they are now charged in their old age.
In addition, the costs of an illness can be, and often are, catastrophic to individuals, and only the very wealthy would have the money to pay for the total costs of care.
Ok, the free-market-solve-everything crowd would say, they would all purchase insurance. But, that is today's system, not everyone purchases it, not everyone can afford it, and private markets in search of profits do what would be expected: they weed out those most likely to add costs.
5.Your health care will be rationed. Don't know how to break this to you, except to say it in a whisper -- your health care is rationed today. Insurance companies do not cover everything, and, when they do, it is often just up to a point. Medicare likewise has certain rules about the level of nursing care required to qualify for reimbursement.
For example, we now know that highly intensive, properly guided physical therapy can restore motor function in people after strokes. A different part of the brain is trained to take over motor control. Here is a real-life case: A professor had a stroke. He is otherwise young and vigorous, formerly a champion-level athlete. But, his insurance will not cover the costs of 12-16 weeks of the highly intensive physical rehabilitation required to recover motor function. He gets just 3 weeks, only one hour on alternate days, but not even at the facility closest to his home, he has to go to one the insurance company approved.
One of the benefits of a comprehensive system is that treating this man for 12-16 weeks so that he can recover his motor function is not only better for the patient but, in the long run, is also much less expensive than forcing him, because of lack of coverage, to remain partially paralyzed. For any given insurance company, however, it is not less expensive, because he is likely to get passed into a different company. Thus, outcomes are worse and costs are higher.
6.Medicare is bankrupt ... or will be in 2042.
Name the private insurance company who is funded for all the healthcare expenses it will have to pay for the next 33 years, and I'll buy you 3 cheeseburgers, freedom fries deep-fried in beef fat with all you can drink Mountain Dew.
Ok, now go to your family and friends, and let them hear it from you.
Happy August!