Monday, November 2, 2009
Good Intention and Hard Economics: Is There A Compromise?
This is my final post on the health care bill (unless something really interesting happens). I've come to the conclusion that health care needs to be reformed - how that goes about happening is a nuanced matter.
I. Two Possible Beasts of Health Care Reform
Adding a government competitor in the private sector would indeed force insurance companies to lower their rates, but there are two problems that may come of this: either the government will put private companies out of business (by providing Low Cost, Good Quality, and Good Access all at the same time, likely requiring taxes to go above 50% of our income), or it will just become a bigger and meaner Medicaid- Low Cost, Good Access, and better-than-no-insurance quality/hopefully better-than-old-Medicaid-quality - so, it would compete with insurance companies, but with slightly lower quality so it doesn't put them out of business completely. Among the problems facing Medicaid which we've already pointed out is that since Medicaid is a last resort, it doesn't have to compete with anyone (you only use Medicaid if you can't afford the other ones). Thus it's inefficient, full of bureaucracy, and, worst of all, habitually discriminated against by doctors because of insufficient coverage. Either choice (government takeover of health care or Big Medicaid) does attempt to address the needs of the disenfranchised, however, and therefore the intentionality is good and is perhaps a first step to sustainable reform.
If this bill passes, I'm going to cross my fingers and hope for the lesser of the two evils - the latter (Big Medicaid)- since the former would cause the wealthiest, most resource-rich country in the western world to end up like the USSR, go bankrupt and owe China more money than we could ever pay back, which is not even remotely a good idea. Even Dr. Powers, who is a huge advocate for health care reform, backed up that probability. Or, in a not-as-bad-but-still-pretty-bad scenario, we end up like Europe - great access to basic health care but high complacency and almost no innovation whatsoever; there's a reason we lead in medicinal research, and there's certainly a place for innovation not just in health care, but in the healthy psychology of a responsible citizen. We must understand that the US Government cannot provide low cost, high access, high quality health care without transforming our economic system into an entirely different creature.
I am going to go ahead and assume that no one wants to revert to a communist system, because it's a bad idea to give any group of people that kind of control over information and basic needs of citizens. If you disagree with that, we have bigger fish to fry - but before you argue with me, do me a favor and pick up a history book. We do want what Communism aims for, though - economic justice and equal dignity for all human persons.
II. If the Government Doesn't Beat Out All Other Insurance Companies and Operates Within a Budget, How Do We Make Sure The Quality Is Better Than Current Medicaid?
So *if* the bill turns out to not take over the private sector in health care, it will be because it has become Big Medicaid (low cost, good access, medium-low quality health care). Think about it - the cost is going to be less than private businesses - so the only way it won't completely bankrupt them is if their quality of coverage isn't quite as good. Big Medicaid isn't necessarily a bad thing if it provides better insurance to more people than the current Medicaid system does. If Big Medicaid allowed better access and lower cost of health insurance to low-income earners, one further reform would have to take place to improve quality as much as possible *without* taking out of taxpayers' wallets or increasing the deficit.
If the Health Care Bill fixes cost and access, it should leave quality up to another reform: requiring hospitals to set salaries for their doctors to reduce overdiagnoses (take away the commission on keeping people sick). In the case of extraordinary procedures that would cost above a certain amount of money, a review board would have to sign off on it to ensure that the money is not ill-spent. That, in and of itself, would attack the heart of discrimination between insurance policies in hospitals - the doctor doesn't personally financially benefit more depending on which insurance policy he gives more attention to. Thus, more quality care will be given to those who benefit from Giant Medicaid than it would otherwise, because doctors will be more willing to treat them in the first place.
Some argue that this would require a government takeover of hospitals; I say that's silly. We already tell businesses how much carbon emissions they're allowed before they get in trouble, for the good and health of all citizens. Oh, hey, wait! We just intervened in private business without taking it over! Look at that!
Telling hospitals to eliminate the commission system for doctors will not be the end of the world; they're just telling them to operate like a normal business, not a sales business - and also, of course, to recognize the humanitarian nature of their chosen field.
So here we're closing the gap between cost/access and quality. Whereas previously high quality necessarily correlated to high cost, and low quality to low cost, instituting salaries would hopefully compromise by offering medium quality for low cost (doctors wouldn't discriminate at least, but if the person can never cover their share of what Big Medicaid can't, the hospitals will possibly start putting the pressure on doctors to decline them service in the interest of business sustainability. Not perfect, but sustainable and better than what we have now, which is discrimination based on perception, not financial history). Hence, I'd identify the quality they offer as medium - not great, but not bad either.
On the flip side, then, there are ways to narrow the gap on the other side - offer high quality for medium cost. There are ways to drive down costs of insurance policies that already are guaranteed good quality without pouring too much money into the system. Once again, I'd like to draw attention to the Mackey Op-Ed that spells out a way to work within our economic system to competitively drive down insurance costs (it truly annoys me that liberal media summarized this article as "anti-health care" since it's really pro-health care, it's just smart about it. Think outside the box, people! Also, wake up and realize that the government's pockets are not bottomless.) Thus, the highest quality health care of Blue Cross/Blue Shield would become more affordable simply as a result of competition with other private health insurance companies.
III. A Realistic, Sustainable Solution to a Pressing Moral Problem
This is by no means a permanent or perfect solution. It doesn't eliminate the gap in health care between income levels, but it does narrow the gap to a more palatable degree. It is, however, sustainable, which is just as important as a bill being morally right - what's the point of a morally correct bill if it dies out or bankrupts the society it intends to fix? We need to find a compromise between sustainability and morality, and we need to be much more cautious about it than we currently are. The government cannot, by the admission of public health experts, offer all three elements - cost, quality, and access - without an enormous shift in how much money goes into the government, and how much control the government has in the private sector - we have seen time and again that a communist state deprives the individual of innovation and sense of personal responsibility. There is a way to implement morally good ideas in our current economic system, a system that we know works better than a communist one.
We must take into account that we have an enormous national deficit, that security-wise we really really don't want to owe money to a country that's very high on the list of possible wartime enemies in the next two decades, and that we're in a recession where people can't handle the exorbitant tax hike that this would require.
IV. Other Concrete Changes that Must Take Place in Order for the Bill to Maintain Moral Integrity
In terms of the health care bills currently on the table, the following concrete reforms must happen (as well as an admission that we cannot provide the same level of quality as Blue Cross/Blue Shield without bankrupting America):
None of the health care bills on the table leave room for conscience rights of doctors - that is, the bill does not explicitly protect doctors from being forced into engaging in acts that they find morally abhorrent - specifically performing abortions.
The intentional absence of this clause is worrying, especially in light of the dramatic increase of federal use of tax dollars to fund abortions, indicating a very leftist lean within the bill itself. The silence of the bill on conscience rights is therefore deafeningly loud, and must be explicitly addressed within the bill.
Furthermore, the 50% of Americans that now morally oppose abortions should not have their hard-earned money going to fund privately-owned abortion clinics.
Finally, provisions must be made for health care for immigrants; this has not been a priority so far and must be made explicit within the bill.