Sunday, April 07, 2013
A History Lesson
Wednesday, August 15, 2012
A Road to Serfdom
Monday, July 25, 2011
A Short Sermon
Sunday, October 04, 2009
The Failure of the Free Market Health Care System
Our national health care debate has included numerous anecdotal accounts of the failures of government-run health care policies. From the blogosphere to the mainstream media – and unfortunately today that includes the Fox network – people have come forward to recount how their relative in Canada, Great Britain, Germany and even Norway suffered illness and eventually died.
The fault is, of course, "socialized health care." Never mind that all of the countries named above have widely different systems of providing health insurance to their citizens. Disregard that not all of these countries practice "socialized health care."
Most of all ignore the fact that under any system, sick people will die and bereaved relatives will be offended and will find fault. Sometimes the faultfinding is justified. Many times grief clouds judgment.
What follows is an account where no one is sick, no one dies. It is anecdotal. Nevertheless, it is a true representation of what happens under the free market capitalist system of health care in the United States of America
A worker for a small concern purchases a high-deductible plan that is combined with a health saving account (HSA). It is the dream plan of the Republican Party. Contributions to the HSA are tax-deductible. Funds from the HSA can be used for the high deductible and health care costs not covered by the health care plan.
It is nice that health care savings are tax-deductible. The worker, however, works for a small firm and has an income that is congruent with working for a small firm. Contributions to the HSA necessarily come after paying for daily living expenses. Then there are the health care costs that drain the HSA even while the worker is trying to build this account with tax-deductible contributions.
This system requires constant vigilance.
Happily, the worker is healthy. The worker has healthy habits. The worker exercises regularly. The worker has a healthy diet. The worker is no athlete, and is not young. The worker is responsible and takes full advantage of the yearly physical examinations and screening tests covered by the high-deductible plan.
The worker pays the premiums of the high-deductible plan for two years, during which time the premiums increase no less than three times.
This is where the tale gets interesting.
After the first examination, a condition is revealed which in and of itself is not life-threatening, but could be serious. There are no symptoms of illness. There is only the possibility of illness.
The premiums for the high-deductible health plan go up again. The worker applies for a lower premium plan from another company. The worker's income has never gone up to meet the increase of the premiums.
The healthy worker is denied coverage by the alternate company because of the non-life-threatening condition revealed in the earlier examination. The worker is stuck with paying a higher premium.
The Republican Party has advocated that the free market system offers workers the freedom to make choices congruent with their income. Citizens can choose their health care providers. They can choose their doctors. They can control costs.
The Republican Party needs to return to planet earth.
The only freedom the present system provides is the freedom of heath care insurers to deny coverage and increase profits.
Anyone who is otherwise healthy will have a "pre-existing" condition simply because they have some existence.
The present system of health care provides no freedom for those who have employer-based insurance. It tethers them to their employer. The present system of health care provides no freedom to those who do not have employer-based insurance. They are at the mercy of companies who can deny coverage for the least reason. The present system provides no freedom for the 45 million who are uninsured. They ignore their symptoms until they need the emergency room. Or they die.
The citizens of the United States are at the mercy of so-called health care insurance providers whose motive is profit and not health care.
Read this essay again. It is not the tale of a sick person needing health care. It is the tale of a healthy person trying to pay for health care in this so-called free market and finding no freedom at all.
This is not my story. I have no health care insurance. I have too many pre-existing conditions. I will probably die before there is a civilized health care system in this greatest country the world has known.
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.