Saturday, June 27, 2009

Health Care: It's Not About Money

posted by Armadillo Joe

For the last couple days and to the detriment of chores and personal hygiene, yours truly has been neck-deep in a scuffle at Facebook over health care. In some ways, it is just like the one I got into back in April over torture, wherein a fairly innocuous initial comment quickly escalated into a sort of Battle Royale in the comments section because Rethugli-goon trolls are the same everywhere on the inter-webs.

The difference this time is that my opponent, while still deeply, horrifically wrong, is smart. Wicked smart. Freaky smart. This guy was the president of the debate club when we were in high-school together back during the Pleistocene Era and his cockiness back then about his quick-wittedness gave him the aire of a weird sort of jock-nerd hybrid (who looks kinda like Ed Helms). Since high school, he went to a high-end, brand-name university and then law school and works now as a high-power corporate attorney in Dallas. The fairly innocuous post I referenced above was about this NPR photo and it was like red meat to hungry wolves.

We have exchanged almost a hundred comment posts totalling probably thousands of words by now. This is also the last post up by either of us as of 4:30 pm EST today and he has yet to respond.

Other than that, I think what follows is fairly self-explanatory.
Thank you for the fraud numbers on Medicare/Medicaid. I had not seen those and I grant that they are a matter of concern, but then fraud is always a risk no matter the source of financing - private, public or some manner of hybrid. You cite the better fraud numbers for private insurance -- which I acknowledge -- as though they are their own self-evident proof of the superiority or your position. I say they are not. I don't really see how the fraud numbers in-and-of themselves themselves constitute an argument against universal health-care. If we have fraud, so what? Investigate it and punish it where necessary.

Furthermore, you continue to insist that this is ALL AND ONLY about money, money, money -- which I contend is still very, very wrong on multiple counts -- and you have not offered a single counterpoint that wasn't an argument from a financial, fiduciary or economic perspective.

If you want to make it about money, though, then OK, let's make it about money for just a little bit longer. I will say that your fraud numbers pale in comparison to these numbers (from this link: - you can check the link for the numbered footnotes.

  • The United States spends nearly $100 billion per year to provide uninsured residents with health services, often for preventable diseases or diseases that physicians could treat more efficiently with earlier diagnosis.14

  • Hospitals provide about $34 billion worth of uncompensated care a year.14

  • Another $37 billion is paid by private and public payers for health services for the uninsured and $26 billion is paid out-of-pocket by those who lack coverage.14

  • The uninsured are 30 to 50 percent more likely to be hospitalized for an avoidable condition, with the average cost of an avoidable hospital stayed estimated to be about $3,300.14

  • The increasing reliance of the uninsured on the emergency department has serious economic implications, since the cost of treating patients is higher in the emergency department than in other outpatient clinics and medical practices.11

  • A study found that 29 percent of people who had health insurance were “underinsured” with coverage so meager they often postponed medical care because of costs.15 Nearly 50 percent overall, and 43 percent of people with health coverage, said they were “somewhat” to “completely” unprepared to cope with a costly medical emergency over the coming year.15
We're already spending way too much money on health-care in this country (note the numbers I cited above about the growth of the health-care sector from 10% to 16% over the last 25 years). When I advocate for universal health care, I know that nothing is cost-free -- that's not what I mean when I say money should be removed from the equation, I'm referring to the depredations of a for-profit health-care system -- I instead contend that the much-vaunted free market hasn't delivered the efficiencies its advocates have been promising us for decades, that for-profit health-care is a self-defeating contradiction and that the federal government is the only organization large and powerful enough to bring this whole mess under control and thus prevent the current financial and bureaucratic chaos from swamping our whole economy, with ruined fortunes for some and illness & death for a great many others.

I'm heartened that you agree with me that we have a problem to solve, but once again you propose the same gussied-up retread of a solution that has failed us again and again: free-markets and competition. We've tried it your way. We've been trying it your way for close on 100 years now and all it ever brought us is a mess we try mightily to clean up once a generation or so. It isn't like we don't have other models for how to structure a working universal health-care system. Other countries have ironed out the problems with the various approaches over the decades, so we should just pick one and get this stupid thing fixed. I vote for the French model and Business Week agrees:

Although the Conservative Party of Britain think theirs is pretty keen, too:

And, with the above, I'm kinda done with engaging you on the money side of this issue. If you want to keep throwing money-based arguments out there, its your prerogative but each time you do it, you reinforce my contention that this is a profoundly moral issue and the opposition are a bunch of amoral, parsimonious bean-counters who care more about protecting a status quo that works for them than recognizing the existence of a social compact which would require them to contribute to the general welfare. This is about how our values as a nation are reflected in our public policy. If money were the only issue that ever mattered, we'd still have a slave-based labor force in the south and children working 90-hour weeks in factories in the north. Sometimes issues are about more than money and when they are, we find a way to pay for what is important to us.

But before you come back at me with more sophistry about DDT or the economically disadvantaged "choosing" not to buy health coverage or what have you -- in an attempt to change the subject by force-feeding some ridiculous or distasteful false dilemma on me by skewing my positions into your own straw-man argument -- I would like you tell me precisely why you don't think this is a moral issue when millions of Americans live in fear of illness and death and economic ruin amid the general prosperity. Enough with the ad absurdum arguments. I ask you to explain why you don't think the language of morality applies on this issue.

For your side, it always and only seems to be about the money and, it seems to me, the mysterious fairy dust of free-market forces are the only mechanisms for delivery of goods and services available to policy-makers. If that is true everywhere and all the time throughout history, then why bother having a government at all?

For my side, it is about social responsibility and, as I see it, the government is the embodiment of that shared commitment to the general welfare. It is the most efficient and equitable organ for the application of our shared values. In the end, if one side contends that they don't share those values, that we can't even agree that the state of our health care system is a moral problem, then merely agreeing to disagree and moving on maintains the grossly unfair status quo. In the last 150 years, we've moved forward on slavery, suffrage, labor rights and civil rights and at every junction we did so with a wealthy opposition that cried to the heavens about the end of the world. Each time civilization survived and people continued to be rich. On this issue, too -- as it always has -- history will move forward without your consent.

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