Tuesday, September 08, 2009

Two Ignored Health Care Facts

Tomorrow, President Barack Obama will address a joint session of Congress about the need for health care reform.

In my short life, I have never witnessed a president throw himself so vigorously into the work of his administration. It would be unfair to say that Mr. Eisenhower golfed through his presidency, Mr. Reagan slept, and Mr. George W. Bush spent much of his time trying to untie his tongue. Nothing near these caricatures will be made of Mr. Obama.

Mr. Obama is faulted for trying to do too much. He has not come near violating the Constitution –an accusation that has been made against a couple of our previous presidents. He is faulted for calling upon the legislative branch of this government to do the work of the people and address the problem of health care. He has vigorously taken his case to the people. Agree or disagree with him – and on many subjects I do disagree with him – Mr. Obama is earning his salary.

Yet, there are two facts central to the health care issue that I predict he will not address. He cannot state the case for reform as vigorously as he should because the nation is in a state of denial about these two central facts.

Health care costs are unacceptably rising for those who have health insurance. There are approximately 45 million who do not have health insurance. Even among those who do have health insurance approximately 25 million are underinsured. These and other figures can be disputed and argued about endlessly.

The two central facts remain.

Everyone gets sick. Everyone dies.

We are dealing with mortality.

President Obama is not the foremost agent feeding our national state of denial on this issue. The fear-mongers on the right ranting about socialism, euthanasia, and a host of other horrors have done the most to keep us from considering the consequences of our undeniable mortality.

Talk to a Republican about health care and he will offer you a tax break.

Hence we have Health Savings Accounts coupled with high deductible insurance plans. This is a great idea on April 15. Unfortunately it does little to deliver necessary heath care.

Taxes do not kill people. Wave the voodoo magic supply-side economic tax wand and remove all the taxes. People will still get sick. They will still die.

We would all like to have the life of Paul Newman. Mr. Newman led a vigorous and productive life for many decades. He was beautiful and gracious. And then he died. His death was relatively quick.

Unfortunately this is not true for most. Some get sick early in life and need care for many years. For others, illness is something that needs little medical attention. Still others need hardly any medical attention for many years, and then there may be years of debilitating illness.

The only bright spot in dealing with our mortality is that we do not all get sick, we do not all die in the same way. The fact that we do not all get sick and die in the same way is, over the years and in the population as a whole, a benefit. It means that financial resources can be pooled. Services can be distributed to those in need from the resources of those who have less need. The morality of this pooling and distribution is that everyone will have some sort of need eventually. Because everyone gets sick, everyone dies.

Our undeniable mortality is exactly why a free market capitalistic economic system fails in the area of health care. To recognize this fact is not to embark on the slippery slope to socialism. Capitalism was not revealed to us by God, and it is, like every human invention, imperfect. There is a time and place to pool our finite resources to deal with life's uncertainties.

Those who say that the United States has the best health care system in the world are living in denial. They are ignoring the rising premiums, the millions of uninsured, the millions of underinsured and the millions who will be losing their insurance in the years to come as our population gets older. They are also ignoring the many other industrially advanced nations that, regardless of their other weaknesses, are in fact doing a better job than the United States in this area.

Capitalism does a fine job of delivering goods and services for our temporal existence. We have the freedom to choose many goods and services we want, ignore what we do not want, save and work for what we desire. In many areas of life where our desires go beyond our means, we can still live and find some degree of happiness.

Health care deals with where we lose our freedom to choose. Illness comes unbidden.

Shopping for a car or a house is a fine activity in the marketplace. Shopping for a cure is an act of desperation.

The failure of free market economics on health care is obvious with for-profit health insurance companies.

The rightful task of any for-profit company is to deliver a profit to its shareholders. For-profit health insurance companies are by definition involved with a conflict of interest. They cannot deliver service to very many ill premium-paying customers without cutting into their shareholders' profits. Yet their premium-paying customers are paying them for exactly that reason –to provide care when illness eventually comes. The several different ways for-profit companies unfairly deny claims will always happen because these companies need to serve their shareholders.

There are many other ways the current health care system fails the citizens of the United States. One does not have to be an economist, a medical authority, a pharmaceutical company executive to see were the problem is.

We need to start with the facts – everyone gets sick, everyone dies.

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