Response to Dan's post about healthcare being a right

Your question about whether health care is a right reminds me of two separate stories, neither of which directly applies. But here goes.

First is my friend Brigid's feelings about the risks that people have the right to take. Her opinion of drinking raw milk is that people should be allowed to do it, but that then they should pay for their own treatment if they contract listeria (I think this is what it is called...) She also says that if you don't vaccinate your child and someone else's (vaccinated) child contracts measles or some other such disease, then you should be held responsible.

Of course, this leads to the question about whether people who pickle their own livers through years of drinking should be paid for by society. Or people who are 100 lbs overweight, or people who eat fast food, or who don't eat organic... In writing this, I think it comes down to the philosophy, "let those who are without sin cast the first stone."

The second is from the only sensible story about health care reform I read during the entire debate: a Dr. wrote that there are two truths we must acknowledge: first, the healthy must pay to take care of the sick, and second, we all die.

From this I get that it is not OK for anyone to say, "I don't want to pay into this health insurance," whatever it ends up being. If you are well, you have an obligation to the sick and should be grateful that you can pay. If you are well, you can rest assured that you, or your parents, or your children, or your brother will need care at some point. Finally, if you somehow got away with selfishly not contributing and then did get sick, it would be inhumane for us to not take care of you, so we will. Since society really has no choice about treating you, you really have no choice about participating in health insurance.

OK, one more story about what health care is a right: For my last two children, the bill for their births was 4,000 and 7,000. The first we paid for, the second was paid for by insurance, but I'd say it was worth it. A friend had preeclampsia for two pregnancies: the first baby was delivered and taken care of for 50,000 and the second cost 250,000. Then I have another friend whose baby was severely disabled and was in and out of the hospital, didn't ever smile or interact with the world past the first few months, and died just before her 3rd birthday. I can't even imagine someone adding the bills up, or deciding the little girl's worth. What I am getting at is that if some health care is a right, some must not be. Your piece says that it is impossible to get this all down in a short article, but I think it might be just plain impossible. If the government recommends that some mammograms are not covered, then it is (basically) deciding that some people will die---the equivalent of at "death panel". If the government says all mammograms are covered, then theoretically someone could get one every month, if she could find a Dr. to do that. We cannot say yes to everything, and what we say no to could make a life-changing difference, or even prevent death. I can't cut that knot, and no one I know of has the moral authority to do that, especially the government.

Finally, when you say that "the people who are most against the individual mandate are most in favor of socialized medicine in the form of medicare," I don't know that I agree. I've seen a few signs, and I certainly haven't read much by Rush Limbaugh or Glen Beck, but in all the articles on WSJ and National Review and other conservative sites, I've never seen anyone who opposes the individual mandate have anything positive to say about medicare, other than "it's not bankrupt yet." Not a ringing endorsement. So either you mean "a few people who oppose the individual mandate are in favor of keeping medicare the way it is," or maybe there are more articles out there which show this kind of sloppy thinking and I just haven't read them yet.

More insurance reform responses

My father-in-law sent me an interesting blog post about health care reform, written from the perspective of someone at a small non-profit hospital in the Ozarks:
http://ochhealthcarereform.blogspot.com/2009/10/reform-letter-to-editor.html

Anyhow, he seems to have 3 main points:

• The much maligned public option is ironically exactly how the biggest for profit insurance agencies started out,
• government run health care (in the form of medicare) pays more than the big for profit insurance companies, and
  
• the government actually pays bills in a timely fashion, whereas the hospital in question has to get its employees to chase down the payments from the insurance company.

The first point is a misunderstanding of the public option, I believe. Creating a number of non-profit insurance companies to provide low cost insurance to the uninsured who cannot afford regular coverage was a separate proposal from the public option, at least according to the health care reporters from NPR. It is a proposal that made sense to me, but it was rejected by some Democrats and so didn't make it into the bill. I think the writer's point of view is also discredited by the number of people interviewed on NPR (in the talk shows and on the news shows) who say that the public option was the best way to get to a single-payer government-run system.

The second point is disputed in the comments, where a commentor from the Northwest says that insurance companies pay above 80% of costs, while Medicare pays 50%. This is what is frustrating about the insurance debate to me---I simply do not have the ability to judge between the two competing claims. Based on this, I'll go with what is "common knowledge," taking the author's viewpoint into consideration.

Finally, he says that the insurance companies do not actually want to pay the bills. I have some experience with this and agree. But on the other hand, Medicare paying the bills right away isn't necessarily a great thing. Peter Orszag testified this spring that Medicare's costs could be cut by 30% without cutting benefits because Medicare is so filled with "waste, fraud and abuse." Presidents have been trying for years to get rid of the unnecessary spending without much success. Also, Medicare is due to go bankrupt in just a few years---this does not fill me with trust in a government run health insurance option.

I think his main point is correct, though---he is afraid this will just be a way to get government money to the health care companies. Like the drug benefit before it, this plan seems to try to fix the problem of access but not of cost, using taxpayer money.

One other part of his post interested me, and that is the idea that his hospital is trying to do the right thing towards people in need, without any rewards from the government or financial rewards. The reason this whole reform is so hard is that the people who are trying just to do the right thing are not the people in charge of the bill and the debate.

Correction: The hospital is a for profit hospital----they just haven't made much of a profit.

Argumentation

Beware the argument your opponents cannot win. If your response means that there is nothing they can do to change your mind, then it's not an argument, just a couple of speeches. If your mind can't be changed, then your opinion becomes less rational and more like a gut reaction. Not that gut reactions should be ignored, but they deserve less respect.

Also beware the argument that lets you dismiss your opponent. Even if they are racist, stupid, liberal, religious, or bound to have wrong ideas for any number of reasons, almost always there is something in their argument that you need to think about. It's better to ignore the person and their motivations for making the argument, and focus on the argument itself. I know, it might lead to an outbreak of civil dialogue, but why not try it?

One of the most frustrating things about this whole health care debate is the way each side doesn't answer the pressing questions of the other. People are getting cut off by their insurance when they need it most for dumb reasons. People who work hard can't afford insurance. On the other hand, someone in the government (as opposed to private insurers) is going to decide what counts as health insurance, what gets covered and for whom. Medicare covers lots of people, but it is going bankrupt, is wasteful, people need additional insurance, and is not controlling costs (it might even be fueling some of the fast increases). Anyhow, these questions are treated rhetorically, not substantively, and I'm getting fed up.

Requiring health insurance

One of the ideas that is being batted around as we talk about universal coverage for health insurance is requiring people to have insurance. Some feel this is unreasonable, that people who are healthy (or who think they are healthy) shouldn't have to pay to be insured. I disagree.

First, we require people to carry insurance on their cars because no one plans to get into an accident. Even the best driver can get rear ended, even the healthiest person can have a gene for cancer or get in an accident or be exposed to a virus. If you decide not to carry health insurance, but then need it, you are cheating the rest of the covered people who pay, even when they are well.

I read someone say that insurance companies should be allowed to not cover pre-existing conditions because getting sick and then getting coverage is cheating the other people in the plan. That's why I think we need to get these people covered in the first place, so that no condition is pre-existing.

That said, I think that having extremely high deductible plans for some people makes sense. They shouldn't be for everyone, but a high deductible plan with a HSA makes sense for healthy people without kids, who don't expect any problems. They're still paying in to the pot, but they shouldn't have to get the deluxe plan.

One thing I've read in this debate that makes sense: The well pay for the sick, and we will all die one day. I think sometimes we forget this and behave as though we need to get something out of health care, or we need our wants taken care of. In reality, we'll all need it someday, and a bit of compassion is a good thing.