I had a death in the family this past friday morning. needless to say that distracted from writing a blog this week. so, here’s an essay on health care that I wrote in college. here’s hoping the wordpress blog doesn’t screw up the formating to much.
I. Problem Situation
Health care in America is becoming a crisis. The main problem stems from costs spiraling out of control. Our actual knowledge about biology and our technology has never been better. It’s just that only the rich can afford it. The rest of us are stuck with insurance companies, all to happy to take our premiums and then when we get a major illness, they find any loophole they can to drop us. Since doctors are out to please third parties and not the actual consumer, the doctor’s loyalty is to saving the insurance company money, not saving your life. An email sent to Michael Moore and read in his documentary Sicko, says it quite clearly: “health insurance companies suck, flat suck” (Moore 2007).
His first half of his movie details various people that had insurance and thought they were covered; only to get screwed by some loophole. For instance a woman who had gotten approved for a surgery but then was denied because a long time ago she had a yeast infection. Another guy dies of cancer because they refuse to pay for his care. And that’s just two stories of many told in Sicko. (Moore 2007) Insurance companies have turned health care into a bureaucratic nightmare with costs nobody can afford. We essentially have the worst elements of socialism with the worst elements of capitalism. Combine this with greedy lawyers suing over every little thing, and costs are driven even higher and innovation weakened even further. Add to this government enforced monopolies on certain drugs and costs become outrageous. Why is aspirin a couple dollars for a bottle but prescription drugs cost so much more?
David Gratzer in his book The Cure, talks about how before 1941 and the discovery of penicillin, most health care was comfort rather than curing, as there wasn’t much that could be done other than controlling fevers, pain and maybe sawing your leg off. (Gratzer 2007. pg 12-15). Then in the last half a century technology has exploded along with costs.
This has lead many to conclude that it is the increase in technology that has caused the out of control costs. In Gratzers book, the question is asked, “why is it that in every other field where enormous technological strides have been made total costs have fallen over time but in health care they have increased?” (Gratzer 2007 pg 34)
The problem is that when wages were controlled during WWII, companies trying to woo workers offered health plans, and the IRS legitimized this by making it tax free, and this has resulted in health care now being mostly covered by employers and this third party system has caused all these problems. If it’s free you have no incentive to save money by choosing a cheaper alternative, and the doctor is under no pressure to find more cost efficient ways to satisfy customers. Thus attempts are made by the third party to cut costs even at the expense of the client’s life. The best person to choose whether a cost is worth it should be the client but he won’t feel obligated to do this if he is spending someone else’s money. (Gratzer 2007 pg 25-38)
Now I agree with Gratzer that we need to fix the problem of being over insured and get it back to patient and doctor and this will cause prices to come down dramatically, but the poor will still need help. Even if prices are reasonable, the poor won’t be able to afford it and I think it is immoral to let anyone die just because they couldn’t afford care. The poor need financial assistance to pay for care. So will middle class people who get catastrophic health problems like, cancer only to be dumped by greedy insurance companies not willing to meet their end of the bargain. We must find a way to harness the competition and innovation and cost savings of free market capitalism that make cell phones cheaper, better and more widespread, with the goals of socialism that makes sure everyone gets help that they need. That is the problem we face.
We need to create a health care system that finds the quickest most efficient way to bring health care to as many as possible and to spawn innovation and get new technologies to people quickly. Clearly, if we can get a cure to cancer to people sooner than later that’s a good thing. So is making sure there aren’t waiting lists that make treatment useless by the time they get to your number. However we must make sure that everyone gets covered. Shortening waiting lists by having poor people not be able to afford care, or by socialist rationing that says fat people and smokers don’t get a turn, are immoral. This isn’t to say we shouldn’t encourage good health, as we should. Prevention must be a very important focus. But at the end of the day we should not abandon citizens because of mistakes they have made.
We need a health care system that puts the choice directly into the people’s hands, instead of some bureaucrat, or greedy insurance company. We need to make sure folks are informed about health care choices so they can make good choices. Things like doctor ratings, treatment success ratios, prices, etc. we need to keep prices down and find cheaper, better, and more efficient ways of treating people, preventing illness, and check ups. Knowing that some will need assistance paying for and getting health care, we must make sure to reduce the stigma attached to such assistance. We need to go after fraud and put those folks in jail. We need to stop greedy lawyers suing over every little thing that raised cost on us all, but make sure real victims can get compensation. We also need to fund research. In short we need a health care system where doctors, drug companies, and makers of medical technology have incentive to find better ways to help us, please us, and find cheaper more efficient ways to do so, and make sure everyone is taken care of.
III. Alternative Policies
One alternative proposed is House Resolution 676. It’s almost what I support but leaves out a key detail. It proposes a fully free market health care system but the government pays for it (but sadly no incentive for you to shop for a good deal, which is key to cost savings). You can go to any doctor you want, get any service you want, and then let the government foot the bill. http://www.hr676.org says
“Basically, House Resolution (H.R.) 676, the “New Expanded Medicare” bill now in sub-committee in the House of Representatives simply creates a new and far more functional “single payer” method of paying for medical services while leaving the medical system itself completely alone and intact. This will eliminate the hundreds of complicated and redundant payment plans currently imposed on the system by private “for profit” health insurance companies and save literally BILLIONS of dollars every year by eliminating such wasteful duplication.” (Citizens Alliance for National Health Insurance)
This sounds nice but only on paper. The whole reason government bureaucrats wind up having to take over socialist government programs is to reduce costs. If people are just given a card and can just go and get care wherever without thought for costs, then there is no incentive for them or their doctor to find cheaper yet equally effective treatments. Thus to keep costs down, rationing is the result, which leads to long wait lists. New treatments have to be approved by the bureaucrats because of how much they might cost. Otherwise if you just leave it to the folks as is, costs would skyrocket to the point of being unmanageable and the whole system would collapse.
Canada has this system. Gratzer is from Canada. Here’s how he describes a Canadian emergency room in his book The Cure.
“On a Cold Canadian morning about a decade ago, late for class, I cut through a hospital emergency room and came upon dozens of people on stretchers waiting, begging, moaning for treatment. Some elderly patients had waited for up to five days in corridors before being admitted to beds. They smelled of urine and sweat.” (Gratzer 2007 pg 2)
Good intentions don’t automatically mean your policies will work and in this case I think HR.676 would be a disaster although still better than our system since five days is better than NEVER. But I think we can do better than this, and I’ll explain how in Part IV of this essay.
Another alternative policy is the creation of what’s known as Medical Savings Accounts. (MSA’s). Joseph Kellard says,
“The only rational, efficient solution to these corrupt reforms are Medical Savings Accounts (MSAs). The amount of money your employer pays in health insurance is invested in a tax- free savings account, which you would use to purchase any health insurance or medical care policy, be it, for example, catastrophic insurance, a $250 deductible, or an HMO. MSAs transfer your money from your employer back to you-to be used for anything you want to spend it on. By instituting a freer market and consumerism, MSAs will put an enormous downward pressure on prices and thus greatly reduce the cost of health care. They will allow individuals to deduct 100 percent of their medical expenses, including their health insurance premiums, from their taxes. Since surplus money from healthier individuals could no longer be used to cover those who need extended care, the healthier would be able to leave pre-paid programs. Therefore, MSAs engender what individuals must possess in a free nation: the personal responsibility to provide for their own medical expenses. They would thereby be required to exercise choice and economy in regard to a medical plan and doctor. (Kellard, 1998)”
The Problem with MSA’s is that the poor and those who do need costly lengthy treatments may be screwed unless they happen to have a savings account. How do you save money if you can barely pay bills as it is? The capitalism driving innovation and cost reduction is great, but if it still costs too much what are you to do? And why would many bother with preventative medicine when that 50-dollar prostate exam could buy their kid a Christmas gift, they otherwise couldn’t afford, or even their electric bill?
Another Alternative is Obama’s health care plan. Of his plan Obama said:
“My plan begins by covering every American. If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the 45 million Americans who don’t have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness.” (Obama, 2007)
Now looking over his webpage his plan seems quite convoluted and is basically regulating the heck out of third party insurance companies, giving them subsidies, and such. This is our system we have now but even worse. What incentive does the insurance companies have to lower their costs? Price controls? This will cause rationing and cost cuts that are not at the benefit of the consumer. What will he do? Regulate this? Force them to cut costs and then tell them what they must support? This will quickly turn into one big bureaucratic mess. The key is consumer choice, and consumers looking for the best deals and this plan will not succeed at this and keep costs down.
IV. Best Alternative
First we have to abolish insurance companies. They are basically legal gambling establishments and like any gambling establishment, the odds are rigged in favor of the house. What happens to the extra money? It goes into the hands of CEOs and other types. Also for things like checkups, which everyone gets. It makes no sense for an insurance company to pay things like that. They get that money from somewhere and want to make a profit at the same time, so this makes it cost more than it should. I say we cut out the middleman. Why pay a doctor AND an insurance company for checkups?
I am actually for a not-for-profit, single payer national health insurance program similar to the one proposed by HR.676. That way every penny that goes into the system is used to help people and everyone is covered and nobody will be dropped or denied for pre-existing conditions and the like. The poor and middle class would pay nothing into the system. The rich have plenty of money for harvesting. Since it is not for profit and only one single payer, there is a lot less forms, muti-bureaucracies and such and would save money and time.
The difference is that in my system folks would not use a card, but would receive cash for what they need. The incentive would be for them to shop around for the best deal, and thus get to keep a little of the money for themselves. If doctors and hospitals and such are forced to have prices that people can compare, and reviews for people to research to see who offers the best care, there would be incentives to offer better care at a lower price than your competitors. Thus over time prices would fall, and amounts given to people by the national system would be adjusted accordingly, and people would keep seeking better deals to get to keep some of the money to spend on themselves.
Now prevention is cheaper than cures so we need to have a good prevention plan. Aside from paying for check ups and such, is doing things like offering good health education in schools and colleges, and on TV, radio, magazines, etc. there needs to be education campaigns. We could also offer tax incentives to food companies to make food healthier. For instance, why can’t they use the artificial sweetener Splenda instead of sugar to make a snickers bar? People addicted to snickers bars would be that much less likely to get diabetes. We could also make sin taxes for food that is bad for you, and subsidize healthy foods, thus making it more likely folks would choose healthy foods more often. How about tax incentives to employers who have exercise breaks for their employees. We need to make sure schools have good P.E. programs. Encourage towns to make more sidewalks and biking tracks.
Lastly there is the research aspect; Coming up with new ways to prevent and cure health problems. Private companies, looking for better alternatives than their competitors, would do a good amount of their own research. However sometimes it’s not profitable such as the case of rare diseases. An example of this is mentioned in a CNN documentary hosted by Dr. Gupta. He shares a story about a kid with a rare form of cancer and an experimental drug called Immtherä that seems to be working, but to which will never make production because and I quote “our marketing people had done research and were never going to be able to recoup our research and development costs” (Gupta, 2005). Okay clearly this is unacceptable and we will need to publicly fund research, especially research for things that would not bring a profit to companies such as rare diseases. We could offer incentives like cash bonuses to have research facilities competing with each other to come up with good ideas and discoveries.
We should give full choice to the consumer not the FDA and we should not allow companies to have monopolies that allow them to sell needed medicine at outrageous prices. There is no reason aspirin should cost a couple bucks for a big bottle and another drug cost several hundred per pill. Now taking away power from the FDA does not say they could not issue recommendations. They and competing groups, doctors and pharmacies could earn consumer trust and give information about various drugs prices and their effectiveness. Now there is an acceptation to this rule. Antibiotics. Abusing antibiotics is a national security risk as that bad choice not only affects that person but all of us by creating super-germs that are incurable. Whatever problems arise from having these drugs monopolized and controlled by the government is far better than creating super-germs because of people misusing them and abusing them.
We need to give consumers full choice. If they want to go to a nurse for their stitches because that’s cheaper, they should be allowed too. This would free up doctors for more important things. If you break a leg you probably don’t even need to see a doctor. A trained nurse could set your leg bone and put a cast on and give you pain pills. (as well as know if you need to see the doctor, just as a doctor knows when to send you to a specialist) all these needless regulations we have now takes the choices way from the consumer and often makes things more costly and complicated than it needs to be.
Lastly we need to put an end to all the frivolous lawsuits that drives up the cost of health care. People who commit fraud should be jailed. People who make mistakes should have this publicly revealed. Drug side effects and the probability of suffering them should be publicly available information. That would be plenty of incentives not to make mistakes. There is no need to make lawyers rich from frivolous suites that hurts us all.
V. Assessing the Feasibility
1. Is the policy under consideration compatible with contemporary “style”?
I would say yes it is. It had the capitalism and consumer choice that has worked so well with the rest of our economy, and the cash given by it is little difference from other cash the government hands out such as welfare checks. Nothing about my plan seems futuristic or behind the times to me.
2. Does the policy contribute to equity and justice?
Yes. My plan makes sure that every single person has the money they need to get the care they need. Nobody is left out, and what’s more everyone has a choice on where to get his or her care. People have incentive to cut costs on their own without sacrificing quality of care, or rationing. After all since doctors can still freely make profits, they would want to expand their practices, not limit them to meet demands issued by bureaucrats.
3. Is the policy compatible with social work values?
Yes. Lets look at a couple of principals form the Social Workers Code of Ethic and see how my plan fits.
“1.01 Commitment to Clients
Social workers’ primary responsibility is to promote the well-being of clients. In general, clients’ interests are primary. However, social workers’ responsibility to the larger society or specific legal obligations may on limited occasions supersede the loyalty owed clients, and clients should be so advised. (Examples include when a social worker is required by law to report that a client has abused a child or has threatened to harm self or others.)”(NASW, 1999)
My plan is exactly that. I want to make sure everyone is healthy. My plan looks out for the wellbeing of my clients, in this case I am an advocate for my client by supporting a health care plan to help them. Right now many people don’t have health care because they can’t afford it. People don’t get preventive care, and many are suffering. I want to end this and thus help their well-being.
Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients’ right to self-determination when, in the social workers’ professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.” (NASW, 1999)
This is precisely why I am for consumer choice. Letting clients choose their own doctors and do their own shopping around to get the best deal they can instead of having bureaucrats decide for them. I am all for educating the client and giving him guidance but I want them to ultimately have the choice in their own hands. I trust my clients to both cut costs and get the best care and thus want them in control, not some third party bureaucrat. This fits right in with the above ethical principal.
4. Is the policy compatible with other important values in society?
Yes. I as an atheist and secular humanist and those like me want the best for humanity. Christians also believe in caring for the sick, the lame and the blind, so do Muslims and, Jews, Buddhists and people of other faiths. My plan also embraces the American entrepreneurial spirit by keeping with the capitalist model and bringing it full fledged into the health care sector, only giving cash aid to those who need it which goes with the belief in helping the less fortunate.
5. Is the policy politically acceptable?
I think it is. I think most people would love my idea with the exception of insurance companies, drug companies, and the like. Most people’s objections to socialized medicine are because of fears of being controlled by government planners and worries of being taxed too much. Show them that most would actually save money on my plan and that it takes advantage of capitalism and I think most would go for it. It would be an entitlement program like social security. That would prevent stigma. The only people I think would take issue are the rich and folks who run insurance companies and prescription drugs, but there’s a lot more of us common folks than these types, so if we get organized we will win the day.
6. Is the policy legal?
Why wouldn’t it be? We already have government-funded health care for some, we already give welfare checks to some, and such. My plan does nothing we don’t already do to some extent. How would it not be legal? besides the lawmakers would be passing the law and making it legal.
7. Does the policy satisfy relevant interest groups?
It sure won’t satisfy the insurance and drug lobbyists. This will take a grassroots effort and the common man making our own interest groups to force the politicians to look out for us, and not the greedy insurance and drug lobbyists that bribe them. This will satisfy the common man, the unions, and probably most businesses that would be paying less than the outrageous costs they are forced to pay now for insurance companies.
8. Is the policy scientifically sound?
My plan supports funding scientific research to improve prevention and curing of health issues. My plan would not support pseudo-scientific crap like new age psychic surgery and such.
9. Is the policy rational?
Yes. I let capitalism do its magic but make sure folks have money to buy what they need. My plan makes perfect rational sense to me. It’s clearly and concise and not garbled up like Obama’s. I had trouble even making heads or tails on his plan and exactly what he wanted to do. It looked to me like he was trying to please everyone, a semi-socialist system that supports the profit making insurance companies. My plan is meant to solve the problems and not trying to please everyone. The insurance companies won’t be pleased and I think that’s good.
10. Is the policy economically feasible and economically superior to other alternatives?
Absolutely. We see that national health care plans are feasible in other countries. If our government didn’t waste money on needless wars, we could easily afford this.
The US Department of Defense, regarding our military budget for 2009 says:
“President George W. Bush today sent to Congress his Defense budget for Fiscal Year 2009. The budget provides $515.4 billion in discretionary authority for the Department of Defense (DoD), a $35.9 billion or 7.5 percent increase over the enacted level for Fiscal Year 2008.” (US Department of Defense, 2008)
Wow! A lot of that is because we act like the worlds police. If we stopped all that nonsense we would be loaded with cash. Lets say we shaved just 1 billion off that budget. That’s about 0.002 percent of the military budget. Now according to the US Census Bureau we have approximately 300 million people in the US. (US Census Bureau, 2008) If my calculations are right, just shaving 0.002 percent of the military budget, we could spend 3 million per person in 2009! And frankly I think we could afford a lot more than that. Can we afford to give everyone health care? Yes we can. We just need to stop wasting so much money on other things.
11. Is the policy workable?
Yes it is. It works very similar to the single payer systems of other countries, which seem to be doing okay, but mine has the added bonus of bringing the benefits of capitalism into the mix. It’s absolutely workable.
12. Is the policy efficient?
Yes. By keeping the capitalist model in health care it will keep costs down. My plan would be to adjust the amounts given as costs dropped to save even more money. Also with less bureaucracies, people will get help much faster. I would have quick approvals and if later, one turns out to be a mistake we could make them pay it back like it was a loan. We could give loans (similar to student loans) for experimental treatments we haven’t approved yet, that folks want to try. Our system is the most costly in the world, and I think combining what the rest of the world is doing with our capitalism would make our system much more efficient
13. Will the policy be likely to generate other social problems?
We could have folks trying to take advantage of the system, but to me that’s a small price to pay. I’d rather a few rip it off, than people die of treatable diseases because they couldn’t afford care. And we already have mechanisms to try and stop fraud. We do it all the time already so I think we could deal with such problems should they arise.
Citizens Alliance for National Health Insurance. What Is National Health Insurance (NHI)? Retrieved on April 23, 2008. http://www.hr676.org/
Gratzer, David (2006). The Cure: How Capitalism Can Save American Healthcare. New York, New York: Encounter Books
Dr. Gupta, Sanjay (reporter) (2005). Taming The Beast: Inside the War on Cancer. [Television News Documentary Episode] CNN Presents. CNN
Kellard, Joseph (1998, April 30) A Health Care Solution: Medical Savings Accounts. Capitalism Magazine. Retrieved April 23, 2008 from http://capmag.com/article.asp?id=46/
Moore, Michael (producer). (2007) Sicko [DVD], Studio: Weinstein Company
NASW. (Approved 1996, revised 1999) Code of Ethics for Social Workers, Washington DC, NASW
Obama, Barack. Speech in Iowa City, IA, May 29, 2007; quote obtained from http://www.barackobama.com/issues/healthcare/ on April 23, 2008
US Census Bureau. US Population Clock Retrieved on April 23, 2008 at http://factfinder.census.gov/home/saff/main.html?_lang=en
US Department of Defense (2008, February 4). FY 2009 Budget Request.
Retrieved April 23, 2008 from