Location: United States

Tuesday, September 13, 2005

Dealing with some Arguments

I found this short post a few day ago and decided that I needed to address some of the arguments expressed in it directly. After all, one of the newest/oldest arguments in partisan politics is that we talk at each other and not with each other. So, here we go...

#1 "It would seem that having a "free" health care system would be too easily abused for small things like hang- nails, scratches & boo-boos, which would likely drive the costs up to a prohibitive level."

First of all, what I have been proposing is not a "free" system - and there's no such thing as a free system anyway. My plan is that any American who wants to do so can buy-in to Medicare B - at full price - and thereby receive some modest amount of health care coverage at a modest price. The going rate would be around $80 per week - and I propose allowing that cost to be paid in pre-tax dollars and split by both employer and employee. Will it result in people going to the doctor more often? Well, yes, it will. That is the whole purpose of having healthcare insurance, isn't it? The idea is that by allowing them to go see a doctor when they have, for example, a chest cold that won't go away before it develops into full-blown pneumonia, you actually spend less money than otherwise.

Will some people abuse the system? Yes. There is no way to have any system of doing anything and not have some person somewhere abuse it. That is not an excuse for doing nothing. What you do is build (and fund) a system that investigates abuse, fraud, and waste. When you find people who are intentionally taking advantage of the system, then you take action.

Let's get real, here. There are definitely people who will sit in the doctor's office for eight hours waiting to be seen for a scratch - literally, a scratch. Do you think these people are not already exerting a cost on the system? Honestly, how much time and money is that scratch going to cost? If you have an honest doctor, it will take five seconds and cost next to nothing. If you have a dishonest doctor - see the above paragraph.

#2 "Government instituted programs, particularly social ones, are inefficient and costly. Once again this would be asking those of us who deal with the drudgery of every day work to support everyone, regardless of their inclination to work. It's grossly unfair to say the least."

According to the 2005 Trustees report, the total cost of administrating the Medicare B and D programs was $2.9 billion for 2004. This is a very slightly more than 2% of all expenditures. Since there were some 33.3 million recipients, this means that Medicare paid administrative costs of $87.09 per patient PER YEAR. In other words, if you pay one week of Medicare B, you have (almost) paid for all administrative costs that would be incurred for the entire year.

As means of comparison, I'll refer you to a health care expert - Matthew Holt. Search down for the term "medical loss ratio". I'll quote:

"From 2000 to 2003, medical loss ratios for the 17 companies dropped from an average of 84.8 percent four years ago to 81.5 percent last year. So while medical expenses have increased, the proportion of dollars devoted to them has dropped."

That means that administrative costs (the part eaten up by non-medical expenses) rose from 15.2% to 18.5%.

Actually, almost all federal social programs carry out their goals at a lower cost than any private company can. The reason is simple - it's an economy of scale. The per unit price of anything goes down as the number of units delivered goes up. Obviously there is a limit to this, but in general, it's why Medicare can keep costs low.

Again, this is not asking anyone to support anyone else. It is simply allowing those who want to (and who have the means to do so) to opt-in to a modest level of health care. What's unfair is that millions of people already pay for Medicare and yet have absolutely no way to qualify for Medicare coverage.

#3 "Of course, the overwhelming rejection of this idea will not stop liberals from pushing socialism on us from now until eternity."

This is the most ignorant argument ever. Generally, it comes from people who have no idea what socialism really is, but they heard Rush or Hannity say it and it sounded good.

Socialism means that government owns industries. Medicare doesn't even compete with the health care industry. In fact, if Medicare failed today, there wouldn't be a single company out there rushing to provide health care for the uninsured - just like they aren't rushing to insure those who are currently uninsured. Health insurers are welcome to start up programs to compete with Medicare any time they want.

#4 "National Health Care is socialized medicine. This has never worked without significant limitations on care. The reason that the Canadian system "works" is that the US is the "pop-off" valve where people can come to get their care."

Again, this is a throw-off line from Rush and Hannity. I've already talked about socialized medicine (which is another way of calling it socialism).

The argument that it doesn't work without limitations on care is simply without merit. We already have a system with even lower limitations on care - a self-pay system that locks the vast majority of Americans out of any other means of obtaining medical care.

As the recent row over Americans buying Canadian drugs shows, it may actually be Americans who are overburdening the Canadian health care system. Even if that isn't true at all, we still have the existing system for the "pop-off" system - no one is going to stop for-profit health care. By making Medicare available to more people, the system may actually be revolutionized where Medi-gap insurance actually can be offered to people everywhere and be a significant source of business for private insurers.

#5 "Heath care costs are being driven higher through malpractice insurance. This could be addressed by socializing tort law, capping pain and suffering claims and accepting that medical science is occasionally impacted by human error. Our citizens need to reconsider the belief that we need be compensated for everything bad that may happen to us. If a doctor is deliberately trying to cause harm, try them in criminal court. Government is hard, cold and shallow. Devoid of religion and steeped in politics. Government is no place to put medical care."

Let's look at the facts of malpractice lawsuits. 70% of all malpractice suits are dropped or thrown out of court. Out of 100 cases brought, only six go to verdict and the plaintiff wins only one case. Some specialties have a higher incidence - notably surgeons and OB/GYNs - and there are specific reasons to address problems with them. Most people, however, don't go to the doctor because they are pregnant or need surgery. The objective here is actually to prevent the need of surgery as much as possible. Early care is the best way to accomplish that.

A large part of the cost of malpractice settlements is also the need to provide life-long health care for the injured party. That cost could be cut to very manageable levels if all that was necessary was to pay Medicare B premiums. The savings would be exponential for OB/GYN's for injuries to babies that have their entire lives to claim health care costs.

I like the "cold, hard, and shallow"government compared to the "war, soft, and deep" market of health insurance argument. Is it really necessary to debunk that?

#6 "The federal government needs to get back to its original purpose as outlined in the Constitution and stop overstepping its bounds. I want less government in my life, not more."

I always love it when people say "We need to stick to the Constitution." Did you eat today? Do you know where your food came from? Do you know who handled it or how it was packaged? Did you take a pill of any kind in the last year? You do realize that the Constitution doesn't authorize a Department of Agriculture, Health Department, or FDA, don't you?

Plus, the Medicare B program is completely voluntary. You want it, you opt-in. You don't want it, you do nothing.

#7 "Bottom line: I'll get worse care and it will cost me more money. I presently have great coverage from my company. If Universal Health Care is passed, my health care will be worse, not better, because my company will drop its plan and enroll me in government plan. Plus, it will cost me more money because my taxes will go up."

You will keep your plan exactly as you have it now. Plus, if you want it, you can buy Medicare B as a back-up. Your healthcare is better, not worse. Plus your taxes won't go up because the opt-in plan pays 100% of the cost.

Your company won't drop your coverage. If anything, it will redistribute its benefits so you will get more for less.

#8 "If you're intellecually honest and truly desire answers to some of these problems, observe what is happening with physician groups locally: Skagit Medical Center no longer accepts new Medicare patients. Edmonds Family Practice is considering opting out of Medicare altogether. MAYO clinic of Jacksonville, Florida opted out of Medicare about a year ago. And you ask if Medicare is the answer to all of our woes? No, it would be merely the beginning. I welcome any reasonable response."

Providers are dropping Medicare because they limit the payment in order to keep the costs down to recipients. If several million new recipients flooded the system with additional funds, part of the money could be used to increase payments to providers.

#9 "I have personall experience with the Canadian & English health care system. They are both on the verge of failure. In England my father was diagnosed with Cancer. He had to wait more than three months to get appropriate treatment. By then it was hopeless. My mother in Canada had to wait 18 months to get a knee operation. Their was a problem and the Doctor had to re- do the operation. You guessed it, she had to get back on the list and wait another 16 months. During this time she could not walk."

I love this argument. Look, if you were here, your parents wouldn't get any kind of care at all unless they could pay for it. At best, they could be declared disabled and get the same care we are already talking about. The thing is, under my plan, you can get coverage as well.

As far as waiting is concerned, the limits in Canada and the UK are due to the government running the hospital, not from offering insurance. Even if you have to wait for 18 months, it's a lot shorter than the five years my mother has been waiting for her knee replacement. With her level of income, it's probably going to take another five years.

I was going to do a "top ten" list out of this, but honestly, this thing is going in circles at this point. The system works at a lower administrative cost than is available for private care. Private industries are not interested in providing care to the uninsured as it cannot be done profitably at their level. If this sounds like a bad idea to you - don't get it. If it sounds like something that would benefit you, though, why should you not be allowed to purchase health insurance?

As I've said before, there is nothing standing in the way of accomplishing this, and cutting the number of uninsured by half, than empty ideology. Americans deserve better. They are promised better by the Declaration of Independence and the Constitution. Continued inaction is a violation of public trust.

Lives - American lives - depend on it.


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