Exchange on Healthcare

Below is an email exchange with a friend on the topic of Healthcare. I had asked him to give me his thoughts on the topic, since I suspected they differed from mine. They did, and perhaps that provides some balance:


Friend:

Well, I'm not going to be much help there. I'm not very medical. I've never really been sick, never had surgery, well oral surgery but I don't think that counts. But anecdotally I can give you some of my experiences.

In 1988 my daughter had bacterial pneumonia and spent 3 days at Children's Hospital ICU. Children's treated us like royalty. Gave us a place to stay next door and full access anytime we wanted it. I think we had Pilgrim Health Care through work which cost me $17 a paycheck. When the bill came from Children's it was around $3000 and it was marked paid in full. No deductible, no questions. And I never looked at it in any detail. Then in the 90's Hillary Clinton got on the healthcare bandwagon. It didn't last long but when she finally gave it up after a couple of years I was paying $34 a paycheck, had a deductible and the system was all screwed up. Thanks Hillary, good job.

In the late 90's Oliver North was running for senate I think. During the campaign he floated a brand new idea of the Health Saving Account. It was then that I got my first explanation of what an HSA was and how it worked. Instead of one Federal watchdog on medical costs, waste, and fraud, HSA's create 300 million watchdogs of the costs charged to their own accounts. Pretty neat idea I thought. Well, Ollie didn't get elected [whew, he was kind of a crazy] but I remembered the HSA. When I retired without any insurance, that was one of the first things we did. Now when we go to the doctor we ask. What is this test for? Why do you need these blood tests? I just had xrays last year, why again this year? Isn't it true that xrays are no longer considered an effective tool for detecting lung cancer? Ok, so why do you order the xrays? etc., etc. etc. I never did that before, And when I look back and compare my attitude before, it's no wonder that all kinds of fraud and abuse takes place. People don't ask. If somebody else is paying, let THEM ask. Well the HSA is your money in your account. The money you put into it is tax deductible and the premiums you pay for catastrophic insurance is also tax deductible.

You want a solution? In my view, there's your solution. Make everyone manage their own health care through their own account. 300 million watch dogs. Can't beat it.

OK, now having said that, I don't want to stop innovation, discovery, invention, etc. You make a strong case against profit, but it is a terrific motivator. The only reason the human gnome was mapped and currently in use by everyone is because they originally thought there was some money to be made from it. Little did they know all the possible applications that would come from it. But pure research is an essential part of a thriving society. Thousands of discoveries have come from it. Pennicillin was discovered without any idea what it's uses might be. Pure research however, is very expensive. Can we really chance not discovering the cure for AIDS, cancer, alzheimers, parkinsons, and dozens of other diseases because we somehow can't afford pure research? Can we really afford to halt the experiments of the supercollider just because no one knows what the results will be used for?

One last idea. Our founding father's did a great job.

We the People of the United States, in Order to form a more perfect Union, establishJustice, insure domestic Tranquility, provide for the common defence, promote thegeneral Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.They could have added "provide for the common education" and/or "provide for the common health care" but they didn't. They only "provide for the common defense" so as to ensure an environment where you as individuals can provide for yourselves.We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.That all men are created equal. Not that all men are equal, but when they are born they are created and begin their lives "equal". After that [by design] you're on your own. And clearly all men are not even close to being equal. And so, by design those of you who are better than the median can provide for yourselves better than those below the median. We are the ones with this wonderful system.

This system that attracts waiting lists of immigrants from all the other countries. Many other countries have nationalized health care. They pay a 40% tax for it. We are a nation of individuals whose individual liberties are ahead of all other concerns. While this quote is a bit out of context, They that can give up essential liberty to obtain a little temporary safety, deserve neither liberty or safety... Franklin It occurs to me that the nationalization of the health care industry would constitute just such a forfiture of liberty. I would advocate an increase in responsibility to the individual for his own well being. I believe nationalization would relieve the individual of all responsibility for their own well being, and as such, violate what Jefferson and his bussies had in mind.



My Reply:

Good morning - funny that you started your last email with "...not going to be much help" then proceeded to pump out a thousand words (997 to be exact). We truly do have some things in common. But plenty not in common too, as I read through your message. That's a good thing.

I'll take issue with your points this way (not sure where it will end):

Many of the arguments you presented are familiar and, for me, quite frustrating when I get into discussions on the subject. I think you set the tone correctly in your first paragraph when you implied that your experience defined your view. Perfectly reasonable. However, I believe the anecdotal approach to defining healthcare is precisely what creates the inertia we find ourselves in, much to the benefit of a select sector of our society.

In those discussions, personal experiences, good and bad, expound ad nausium. Further, people quote the personal experience of other people (as in other countries) with virtually no recollection of the source for that information. I find it frustrating that I can't (in a polite and un-aggressive way) get those individuals to look at the bigger picture. I feel it is the same, almost lemming mentality that viewed the dot.com companies in the late 90s and real estate in the mid 2000s on the other side of the balance sheet. You can make opposing lists of stories about how each system (profit/single payer) works and doesn't work that could stretch to the moon. The winner in that kind of analysis is always the status quo. People have just got to ask the question: who doesn't want things to change?

It's all about cost. Not about your cost or his cost or my cost, but the total cost. You read the piece I wrote last year, so I shouldn't need to repeat. But I just don't understand why one of the verifiable facts about healthcare doesn't resonate - total cost. People hear healthcare in Britain is great, others hear horror stories, it can all be suspect, but the fact is as a nation they care for 2.4 people for every one we take care of here (and their system is expensive by world wide standards). Why doesn't that make people here spin in their seats? Every other quantitative fact regarding healthcare (death rates, infant mortality, per capita hospital beds - US#27, per capita Drs US#52, etc) the US is either on par or below other countries. What are we getting for this huge transfer of wealth, and who's getting the money? Why is it so difficult for people to see that the (dis)information they receive about how (anecdotally) we have such a great medical system is most likely being provided by those who stand to lose if we converted to a single payer system.

Take your research argument, a popular one. Still, most medical research in this country today is done through our University system and it is mostly (if not nearly entirely) publicly funded (which includes charity - bolstered by tax policy as you described). The private (multi-national) pharmaceutical industry operating in this country has become so focused on profits and ROE that they've become counter-productive as expeditures directly relate to healthcare research. Did you read my piece on drug advertising? That aspect is like a metaphor for the entire industry. There are very few other countries that allow such to exist - for very good reason. To make the assumption that very smart dedicated people will stop pursuing careers in medical research because they won't make mega dollars at some corporation is unreasonable and doesn't reflect human behavior accurately. I would venture many if not most of those kinds of people hate working for such companies (simply because of the pressures for profits and ROE), are less productive, and work shorter careers because they can't wait to get out of that atmosphere (I clearly and personally empathize with that).

I don't even think the tax debate is relevant. We pay it one way or the other. For myself alone I pay (with my company subsidized insurance) about $8500 a year in insurance and deductibles. My tax could skyrocket and I'd be no worse off. Although with our system I am also given (at no extra cost) the added anxiety of never knowing if my own insurance costs will eventually outpace my resources or if medical illness or accident to anyone in my family will wipe out my assets. Of course, that may oddly help medical costs, since that kind of stress probably cuts years off of people's lives.

You provide a good Libertarian approach to managing cost, but I really believe that ideal ended in this country a hundred and fifty million people ago, at a time when technology was less complex and the profit aspect of medicine (by comparison to today) didn't really exist. Remember profit is defined as that in excess of fixed and variable expenditures (which includes labor). The healthcare industry in this country today (as I wrote) is almost totally inelastic. The demand side of the equation is currently unaffected by price increase. We either pay, exhaust our resources and have government pay, or decline services and die. There is virtually no impetus in the private sector for efficiency in medical care, because to do so would reduce profits, dollar for dollar. You may wisely refuse an x-ray today, but try doing it when your 85 and drooling in your wheel chair. Besides, you still pay the cost whether it's you getting the x-ray or the crack addict who bumbles into the emergency room. There has to be oversight in an industry which must meet the needs of every human in the country.

Despite what you say, I don't sense you're an 'everyone for himself' kind of guy, where healthcare is only for those smart, clever, and resourceful (or lucky) enough to properly work the system. However, you are correct that if access to adequate healthcare is not considered one of those basic "all men are created equal" inalienable rights (maybe under the “Life” right), then nationalized healthcare has no place in this country. Then you would also need to start advocating the elimination of the publicly supported healthcare already in this country (which is huge - Medicare being the biggest piece - and supplies much of the profit to the private sector) and get ready to start looking like most other third world countries with deformed children begging in the streets with their inalienable right for the pursuit of happiness.