Government-sponsored health care suffers a blow today

September 29, 2009

I’m sitting in a hospital waiting room in Florida while my mother undergoes surgery for a (thankfully, benign) brain tumor. In fact, as soon as I get done typing this, I need to go visit her in her room. The family waiting room, happily, has wireless Internet access, as well as a big-screen TV that’s been permanently tuned in to CNN. I don’t know if that’s because the staff have the remote, or simply because none of us has the stones to get up and change the channel.

So all day, we’ve been subjected to saturation PSA’s from the President about what the “public option” plan he proposes is not: It’s not a slippery slope to a single-payer program. It’s not a method of taking away your choice. “If you have a private plan,” he’s said all day, “you get to keep it.” He’s promised that the plan he proposes will prevent insurance companies from denying applicants coverage based on pre-existing conditions. He promises that this plan will compel the insurance companies to pay for basic preventative measures “such as regular checkups, mammograms, and colonoscopies.”  He’s also saying in this PSA that finally, regular families will be able to get the care they need without going broke.

As my friends at Camden Yards would say: Negro, please.

I know this President is ten tons smarter than his predecessor, so I’m confident he understands what he is saying is simply not true. So I have to wonder: Is he trying to convince himself of what he’s saying, or is he hoping we are too stupid to discern that these things are simply not true?

First and most important: Having coverage does not guarantee access to care. I’ve been saying this for a long time, but I’m by no means unique. Many others have said the same and presented the statistics to back it up, as have I. There is a shortage of providers nationwide. You cannot increase demand artificially without increasing supply. The result is rationing. Ask anyone in Canada or England.

Second, from a liberty-minded viewpoint, government forcing companies to do its bidding is just as bad as, if not worse than, government forcing individuals to do its bidding. Mr. Obama plainly stated in this PSA that insurance companies would be prohibited from denying applicants coverage, dropping sick customers from current coverage, raising premiums when someone got sick, imposing caps on coverage, and raising the patient’s share of required out-of-pocket expenses. So basically, the government is telling the insurance companies how to do business. The above regulations cost these companies money. What will they do? …Pass the increased costs, especially the costs of being forced to accept applicants who are very sick, on to the rest of us. Individuals and employers. To some smaller companies, the added cost may prove to be too much of a burden. Some people will lose their jobs as a result.  Not quite the result he was shooting for, I’m sure. Remember, liberty for businesses is just as important as liberty for individuals, and this is a great laboratory on why.

Third, and this isn’t just a government thing, mammograms and colonoscopies are not really preventative. Mammograms, by definition, detect. Therefore, they work only when there’s something there to detect.In other words, they don’t prevent; they only detect what’s already there.  (I remember being cynical when mammograms were heavily promoted as being the “latest and greatest” in breast cancer care. I was cynical because at that time, about twenty years ago I guess, I felt that research on a true cure for a women’s health issue was being given short shrift. While millions were being spent on cures for men’s health issues, the best they could do for women was early detection.) Colonoscopies, of which I’ve had one, are basically the same thing: they can’t prevent, only detect what’s already there. In the PSA, Mr. Obama promised these services free to low-income folks. My fear is that they will be overutilized and even abused, which costs all of us money, because guess who’s going to be paying for it?!

I’ve been grumpy about this whole issue lately because I feel powerless to do much about it, my Congressman being on the committee that drafted the House bill. So he’s not going to vote against it. Not to mention that his constituency largely favors it. That’s ok; I can live with him representing his constituency. But it would be spitting into the wind to ask him to vote no.

Today, the Senate Finance Committee voted down the “public option” compromise: http://www.cnn.com/2009/POLITICS/09/29/senate.public.option/index.html For now, I breathe a sigh of relief.

There are ways to provide for poor sick people without the government making us all pay for it:

  • In 2007, I did some consulting for two pharmaceutical companies. I won’t name them, but they are two of the biggest players in the industry, and you’d recognize their names. Both of them have “compassionate” programs to make sure poor patients get the drugs they need at little or no cost to them. It’s a good PR move for them, and because the patients are getting proven drugs, not experimental ones, the cost of R&D has long been absorbed and the cost to the companies to provide the drugs is lower than you would think. In fact, the cost can be part of the marketing budget, precisely because it is good PR.
  • In 1998, I worked for a small non-profit that provided advocacy to seriously ill patients. For the indigent, a co-pay of $1 was all they needed to get a prescription filled. In a minimal-government scenario, charitable donations would cover the remainder of the cost. And let’s face it: If you had more in your paycheck because of lower taxes, wouldn’t you contribute more to charity?
  • Looking at the model of the pharmaceutical companies I mention above, I could see insurance companies doing the same. In the name of free-market competition, they could offer similar programs to folks who have trouble paying for simple services like checkups, mammograms, and colonoscopies. Perhaps some companies would ally with teaching hospitals to do patient outreach in low-income areas. (Maybe some do already!)
  • Some doctors accept no insurance. That leaves them free to charge whatever they want. Including $0, if they so choose. I do allow that this is a better strategy for doctors who have paid off their student loans and have established practices than it is for new med school graduates. I currently see a specialist who meets this description for an ongoing condition I have. I pay his full fee because I can. Others may not pay his full fee.

It’s too bad Mr. Obama chose this issue to tackle first in his administration. He’s alienating a lot of people. I understand he wants to demonstrate that he’s a take-charge kind of guy, but he would have won more points with another issue the American people are less divided on, like bringing our troops home from Iraq. As of today, I don’t think it’s too late for him to switch gears. If he continues to beat this almost-dead horse, people will remember in 2012.

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