As action cranks up again in Washington, I have been thinking in the last few days about the progress of health care reform and all that I have read and heard about the issue. All aspects - from philosophy, to goals, mechanics, and international comparisons - has been hashed, rehashed, twisted, and distorted so many times that, if you are like me, it makes your head spin, stomach turn, and brain hurt. Pushing all that aside, there are two primary aspects of this debate that I try to keep in the forefront of my mind.
1. The most important goal of reform should be lower costs for those paying for health care coverage. Easier said that done, right? Right. There a whole host of avenues for potentially accomplishing cost reduction. I have discussed some of these in the past (
here and
here). The
reemergence of a public option in the Senate proposals is encouraging. While health insurance providers are not by any means solely to blame for the recent and continued increase in the cost of health care, they are certainly one culprit. A public insurance
option might be the best way to keep insurance companies honest. And let's clear the air - a public option
is not, and should not be called, a government takeover of health care. This would be particularly true if Sen. Reid's proposal finds its way into law;
his bill includes a opt-out clause for states who do not want to participate (or, ahem, do not want their citizens to be able to participate) in the public option. (As the linked article explores, that opt-out of a federal program could have much more far-reaching consequences for other areas where federal law applies universally.) Opponents of the public option cry that it might run private health insurers out of business. My answer to that is . . . PRECISELY! In its best form, the public option would be a low-cost player in the market that forces other players to examine business practices and make adjustments to remain competitive. Is that not what our economic system is built on?
But back to my first point. For me, the mechanism is less important than achievement of the overall goal of lowering costs. In
another post, I highlighted a statistic from Newsweek claiming that in the next few years, twenty percent (20%) of the U.S. GDP will be spent on health care related services. Twenty. Percent. Health. Care. The administration's economic recovery strategy has targeted automobile purchases, home loans, and debt relief. While those are no doubt problematic aspects of many consumer's economic portfolios, the government would be remiss, if not negligent, if it blows this opportunity to impact what is doubtless a huge expense for many consumers.
2. At the core, health care is a moral issue. Despite attempts to relegate health care reform to the pens of political issues or economic matters, the provision of basic, affordable health care should be a addressed as a moral issue. Our nation is founded on the principle that every person should have the right to pursue life, liberty, and happiness. I have never seen any qualifiers applied to that right. To clarify, I certainly do not believe that anyone has the right to have life, liberty, or happiness handed to them. But in the United States, we guarantee people that right to pursue them. To me, that means removing roadblocks, particularly those to obstruct only certain members or classes of our society.
Let me describe a scenario that I play over and over in my mind. While I will concede that it is an extreme, worst-case scenario, it is nonetheless one that is unnervingly close to reality for an increasing sector of the population:
Bill has a job. Its a good job, not great, but it pays the bills, and his employer provides group health coverage. Bill works hard and has managed to put away some money over the years, but he'd be far from comfortable if he lost his job. Due to the economic climate, Bill's employer is forced to make some hard decisions and has to lay off Bill and several other employees. Bill doesn't qualify for Medicaid and cannot find an private insurance plan that he can afford, so opts to play the odds and go without health coverage until he can find a new job.
Bill gets a job interview. It goes well, and he leaves the interview hopeful. The interview was downtown. Bill is cheerful as he walks from the office building toward his car, parked two blocks away. Bill stops at a crosswalk and proceeds after the traffic signals indicates he may do so. About halfway through the intersection, Bill hears car horns and looks up to see Fred's car speeding through a red light into the intersection. Fred plows into Bill, severely injuring him. Fred was wasted and hardly had any idea what was going on when the police pulled him out of his car. He vomited when he saw Bill, bleeding and motionless, lifted onto a gurney and hoisted into an ambulance.
Bill's injuries are terrible, but he recovers well enough after spending two weeks in the hospital, including a couple days in the ICU. A few weeks after discharge, he receives a bill from the hospital. Obviously, Bill can't afford the tens of thousands of dollars he now owes the hospital, ambulance service, and other care providers. He hires a lawyer on a contingent basis and files a civil suit against Fred. The case is a classic "open and shut." In frustration, the judge throws the book at Fred, literally, and the jury finds that Fred was reckless in his actions that day. They order him to pay all of Bill's medical fees and then some.
But Fred has the last laugh. He has no auto insurance. He also has nothing to his name. No assets. No bank account. No job from which to garnish wages. All he had was his beater car, which he totaled when he smashed into Bill. Bill has a judgment in his favor, but that's it. Bill's savings are far from sufficient to cover his debts, and he files for bankruptcy. Bankruptcy - over the medical bills he accrued through no fault of his own. Bill comes through bankruptcy with nothing except a black mark on his personal credit.
Extreme? Yes, I'll give you that. Silly? Maybe. Unlikely? Maybe. Impossible? Hardly. Heck, the story doesn't even have to include an insured pedestrian. It could be about one whose insurance company denies the claim after getting the price tag - also not unheard of. It could be someone with a high deductible plan provided by his employer. A run of hard luck, and he doesn't have the funds to meet the deductible. The point is that we live in a country where you or I could find ourselves bankrupt because of another's poor judgment. The Newsweek articles I cited in
another post explain that the U.S. is the only Western nation where that is allowed to happen. We're a wealthy nation. We're a nation that places itself on a moral high ground. I cannot find any reason for that possibility to exist.
OK, deep breath . . . and . . . I'm done. Almost. I tell that story simply to illustrate some of the principles our current health care system implicitly endorses. They certainly are not principles which seem to comport with the pursuit of life, liberty, and happiness. I will say this once again: I do not believe that those "inalienable rights" require the government to give handouts, freebies, or whatever. But I do believe it requires the government at least alleviate obvious obstructions put in place by other parties that hinder some individuals from pursuing those dreams.
As I said in opening, the details and rhetoric of the health care reform debate can be overwhelming and nauseating. But keeping a few guiding principles in mind can hopefully keep us and our lawmakers focused on the ultimate prize.
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