The Health Care Debate: Injecting Reality

The health care debate is driving me nuts. It is typical politics at play, where each side takes up positions that are so radical that they know they will never work. Why? Because they will compromise somewhere in the middle. This gives them a chance to cover their asses when it comes election time. They will be able to look at their constituents, point to a change in the bill however minor, claimed that that was their doing, and bask in glory of reelection.

What gets lost in all of this is the human factor. Politicians assume that the public is stupider than they are. I know, hard to believe, but politicians are just that dumb. Politicians, after all, are those people who are good at winning elections. Winning elections, alas, has nothing to do with being able to govern. All too many of the politicians in Washington are marginal intellects and they live in fear of mobs who follow monosynaptic windbags on cable television and talk radio.

Let’s break things down. First, is there anyone who truly believes that some poor soul lying in the gutter, bleeding profusely, because some car has just hit him, does not deserve medical care? That should be a rhetorical question, but there are those who would claim that if that poor soul is not in the country legally or does not have insurance or, for you libertarians, can’t crawl out of the gutter to the emergency room by himself, he should just suck it up and die. In that way he would just be accepting responsibility for his own behavior which, in this case, involved being in a crosswalk at the wrong time.

I believe he deserves medical care. Some people suggest that medical care is a privilege, and since the Constitution does not mention it, it clearly cannot be a right. It is my sense that were medical science actually a science at the time of the founding of this country, the right to affordable medical care would have been inserted into the Bill of Rights. Caring for the poor and the indigent after all certainly is the Christian thing to do, a point often overlooked by those who claim that this is a Christian nation. (Matthew 25: 34-40 (41-46 for those who don’t believe me.))

What I find most revolting about the current debate is that it’s centered around profit. The idea that there might be a public option is one that is used to scare people into believing that they won’t get the care they deserve, and that the public option will put all of the insurance companies out of business. In short, enemies of the public option argue two diametrically opposed things: that the government is so inefficient it will not be able to provide people care, but it is so incredibly efficient that it will drive private business into bankruptcy. And a bonus: it will bankrupt the United States at the same time.

Clearly these arguments cannot both be true at the same time.

Since the goal is to make sure that people get the health care they need, putting together a plan should not be that difficult. The people are not stupid. There’s not a single soul in United States who believes that they will not have to pay for care one way or the other. Pretending that it will be free is just stupid. Everyone knows the politicians are lying when they make that promise. A public option may make it affordable. A public option may cause competition which drives down prices. But we’re still paying and we all know that.

So how do we fund this thing?

I have long been an advocate of something that I refer to as a health tariff. I use the word tariff to avoid that odious term tax. I don’t expect anyone to be fooled, save a few politicians. It works this way: for every bit of snack food, every bit of fatty food, or sweet foods or alcohol that we buy, $.25 is added to the price. Yes, I know this is a regressive tax. My thinking is this: if $.25 means you can’t afford a bag of chips, you can’t afford the health consequences of a bag of chips. This health tariff will force people to be cognizant of the daily decisions they make and the effect that their decisions have on their long-term health.

We collect the health tariff and put all of that money into one big fund. That fund is used to underwrite health care for Americans. It will not fund healthcare entirely and if people get smart it might go away, but that also means that people will be making choices which are better for them long-term, thereby driving down health costs. The health tariff is a simple variation on the old sin tax idea. We know that taxing smoking has not eliminated it, nor has it eliminated drinking. With the health tariff we will be getting some value out of destructive behaviors.

And at a quarter a pop, people who whine too much will just be seen as weenies.

Here’s the fun thing: if you don’t want to pay the health tariff, you don’t have to. Make an intelligent decision and you get off scott free. If you decide to indulge, to have those fries, then you pay.

Having grown up in a household where my father was a doctor, and having worked in his office while I was in college, I love the medical profession. My father and his partners worked long hours. Every year during the holidays I watched them write off tens of thousands of dollars in money owed to them by families who could not pay and yet were not eligible for Medicaid. They work very hard—you try telling someone their child has six months to live and see what that does for your day. They went in early, got home late and someone was always on call on nights and weekends and holidays so that patients in need of medical care were never left without.

That being said, for-profit medical care really skeevs me out. I understand that we don’t want our medical facilities to lose money. I understand we want doctors to be able to make a decent living. I know there are lots of things like malpractice insurance premiums that have to be paid, and medical school loans. The idea however that hospitals have become corporations, and have Board of Directors who have no medical training whatsoever, who treat medical care like a business the same way hog slaughterers treat pork, really leaves me cold. While the law may prevent a facility for refusing to take a patient, there are countless stories about individuals who do not have insurance being quickly turfed out to county medical facilities so the burden of their care falls on taxpayers.

In short, rationing of care already happens.

I think that for-profit medicine should go away. Not a question of my being a socialist, just a realist. Business models change. I know because I’m watching publishing change around me. 20 or 30 years ago I would’ve never had a worry in the world about my career after having 40 books in print. Now that track record means absolutely nothing, and this would bother me more, but I’m watching publishing stumbled blindly into an abyss – unable to change or to survive. And while some of you would note that being an author is entirely different than being a doctor, I would agree. I am not licensed by the state to dispense drugs or to do things which, outside a hospital, would constitute assault, battery, attempted murder, or negligent homicide. (You try removing a gallbladder in the street and see what sort of jail time you do.)

Medical professionals provide a service, and if you know any of them, you know the profit motive is not high on their list. Dealing with people on a daily basis who are having the worst time of their life is something for which no one can be compensated enough. Medical professionals feel a higher calling. I’m glad they do. They watch out for their patients as best they can.

As best the current situation allows them to.

About 10 years ago I visited the doctor because I was wheezing a lot. He diagnosed me as having asthma. But before he wrote that diagnosis down in my chart, he asked me, “How long have you had your insurance?” I asked why that made the difference and he said that some insurance companies give new patients difficulty over such a diagnosis. Again to the point I raised earlier, care is being rationed and healthcare individuals have to jump through hoops imposed by bureaucrats – private bureaucrats in this case – which has nothing to do with the care the patient needs.

So to me this debate is all useless. This is because the course is fairly clear. We need to provide care to everyone. We need to pay for it. Everyone knows they’re gonna be taxed on one level or another so we might as well have that up front. And we need a public option to provide competition so that prices will be kept reasonable. Anyone who argues that government corruption will make sure that that doesn’t work should explain to me how private corporation corruption is any better or works for anybody except CEOs being compensated in the millions by profiting off the agonies of millions.

I find it highly ironic that the politicians who are deciding the fate of the healthcare bill have one of the best healthcare plans in the nation in place, and have had their campaigns funded by those individuals who profiteer from misery. Conflict of interest, anyone? I realize that conflicts of interest are standard operating procedure in Washington today, and have been for, gosh, the last two centuries anyway. But now is really the time for politicians to strap on a pair, defy their corporate masters, and actually do the job for which they were elected: which is to see to the greater welfare of the people of this nation.

And as for those insurance companies and others who wish to profit, they’ll do exactly what has been done with Medicare. They’ll set up supplemental insurance to cover the things which Medicare will not, and facilities to do the procedures that are not authorized by national healthcare. They will still be around, they will still make their money, but not so many people will suffer to pay for their country clubs, their second and third vacation homes, and their lavish vacations to places others can only dream about visiting.

This isn’t rocket science. Give us what we need, give us a reasonable means of funding it, and it will all work out.