Sunday, March 14, 2010

The Problem with Health Care: a Response

My previous article didn't discuss the problem with the US Health Care System, it only stated there was a problem and moved on. However, reading the comments posted by AFuss I thought it would be good to ask the question: "What is wrong with the US Health Care System?"

I think it can be taken as a truism that the US Health Care System (as a whole) is somewhat broken. It appears people from both sides of the political spectrum agree on that. Exactly how it's broken is somewhat up for debate, and how to fix it is up for even more debate. This post will not address how to fix it, rather discuss the problem itself.

When looking at what is broken, there are several aspects to consider (among others which I will not address):

1) what is the goal of the health care system -- For example, is the goal of the system to provide coverage for the rich only? Or is the system's goal to provide coverage for everyone? and to what level? Should the system provide free plastic surgery for everyone? etc...

2) does the nation have the material (including human and physical capitol) required to fix it. IE, do we have the goods required to implement the needs of #1?

First off, I would argue two central points:

A) question #1 (above) is subjective and there exists not even close agreement among the national body. Even when there is broad agreement there is a devil in the details. For example, I believe that it should be our goal to provide a basic level of health care for everyone in America. I think many people agree with this. However, I would speculate that there is broad disagreement about what "Basic" is.... does it include face lifts? (okay, probably there s broad disagreement that it doesn't), but what about providing (at government expense) for a triple bypass for a patent that is 104 years old and already a vegetable? What about one who isn't a vegetable, or one who is 96? Should the country foot the bill? What if the cost is 1 Million dollars and the chance of survival is 0.0005? What if the chance of survival is 0.3?

B) I believe #2 is true, for basically any definition of question #1. By this I mean that any definition you arrive at for #1, the US has the resources to provide it at *some* (unspecified cost). This is different than, lets say Cuba, where the doctors are perhaps very good but there is very little cutting edge technology. Or Nigeria, or perhaps most of Europe. Obviously this is arguable but please note that people from broad chunks of the world come to the United States to get treatment when things are dire. They pay through the teeth, but the Saudi Royal family still comes to MGH in Boston. Europe is much closer, but to Boston and NY they go.

Alright, groundwork aside, I am going to hypothosize that "US Health Care is broken, not because the quality of care offered is substandard, but because many people in the US can't get the high quality of care available in the US because they can't afford it." Read this another way: "The care available to those with money in the US is second to none, but that care is not broadly available to the lower middle class."

A few side notes about the above:

1) There is very good care available to the extremely poor through medicaid (Government health care).
2) There is a gap between the middle (or perhaps upper middle) class, and lower middle class in terms of health care. For those in the country who have health care coverage, life is pretty good. A huge chunk of the country gets health care coverage from their employers and the coverage they get is typically pretty good.

Let me add another part to the overall problem. Not only is there a chunk of the population without coverage, but there is also a chunk of the population who has coverage, but pays quite a bit for it. So the problem is two fold, some people don't have good coverage, and some who do (those believe that 15k a year isn't pocket change) struggle to pay for it.

Are you with me? Do you agree? I think a huge chunk of Democrats do agree with my statements above. You don't actually need to agree on a strict answer to question #1 to agree with this.

Let me take it one step further and reword my argument: "Good health care is too expensive." Yes, my argument is 100% that health care is too expensive. If you could buy the same health care Donald Trump gets for himself for $1 a year, do you think anyone would complain? So its really the cost that's the problem. Cost is why lots of American's don't have health care. We can even take this further: If you don't have a good answer for #1, its still just a matter of money. If we had unlimited money, we could provide the top level care for everyone just as long as we agree that quality care is possible in the US (question #2).

Ok, that's the problem. That's also why I completely disagree with AFuss's comment

"I don't think that Democrats side step the issue -- it's just that they don't give the answer most people want to hear. The answer they do give is: the cost is less important to us than the well being of others."

If we take this statement to be true, then we are saying Democrats believe problem isn't price, but rather the Quality of care in the US. IE, even the rich get shitty care in the US. But, that argument is problematic because rich people come to the US for health care! So there must be really good health care here, at least for the people with money. It brings me back around to the problem being that many people can't afford the care the rich people get. And if you believe that then the *whole* problem is cost.

AFuss seems to agree with my premise that costs will go up. Additionally, costs will go up for everyone who currently has an insurance plan. Mind you, my argument was not that taxes will go up for everyone, it was that everyone who currently has private insurance will now pay more. Actually, anyone who has public insurance will also pay more, but lets not argue that now: thats a much bigger topic. That means people in the mid, to upper middle class will now have to pay more for insurance. That also means the cut off for the afford /can't afford decision will now go up and more people will be uninsured. And that makes the problem worse.


A Fuss said...

Hmmm, well, AFuss will now respond that you are now taking my comment out of context. My comment responded to your previous article that by demanding that health care do things like not drop people, that health care would be more expensive. And that Democrats weren't answering the question about whether or not we believed health care would be more expensive. So I'll reiterate, if it means protecting people from being dropped from coverage or not being allowed to have health coverage because they have asthma or something, yes, all of our health care should be more expensive. We as a society have an obligation towards the greater good. That's what the democrats are saying.

Net Ghost said...

It seems to me that in theory, the U.S. should welcome a plan that provides health care to everyone. Many people say that we have a duty to provide it, and that if it's more expensive, then that's just something that the American public has to accept.

This "greater good" stuff sounds great, right? The problem comes when you pin those same people down about how to pay for it. Because those same people aren't always so thrilled about paying taxes (yes, even Democrats don't like paying taxes). And they don't always support legislators that advocate for increased taxes.

The other problem is that the greater good suffers when you don't solve problems relating to cost, as JK^2 discussed in his prior post.