Topic: Health Care
Universal Health Care and Clean Drinking Water Our nation is blessed with great wealth. Can we not provide basic health services for all citizens?by World
(Libertarian)
Wednesday, January 30, 2008
Few will argue that the United States is a nation blessed with great resources and wealth. While many third world citizens struggle to find clean water on a daily basis, our nation has plenty to spare and society has seen to it that it is readily available for all through public drinking fountains, etc. Free, clean drinking water seems like a reasonable thing for the government to provide. It may require large resevoirs, pipes and / or desalination plants but the cost is small compared to our GDP and the amount of water borne illness prevented probably saves the nation money in the long run.
As a provider of health care, I sometimes wonder why that arguement cannot apply to universal health care. I'm not talking about the monstrous programs suggested by Hilary and Obama where every citizen receives "presidential level health care". Something more modest. A governmental system which provides emergency surgery (not elective surgery), generic drugs (not the newest and most expensive), free clinics (maybe run by our resident physicians in training). Why should your tax dollars go to paying for this you might ask? Well for one, they already are. Uninsured patients can visit the emergency room at whim and receive care, even for non emergent conditions. Many use our ERs as "free clinics" already and hospitals are not allowed to turn them away. They may get a bill, but most will go unpaid, or they may have provided incorrect biling information. Secondly, we provide these services for those who are incarcerated, why should those in jail have better health care than a law abiding citizen?
It would take a overhaul of our expectations of our health care system. For the same reasons that everyone in this country cannot drive a new Lexus or Mercedes, we cannot afford to provide "congressional or presidential" care to every citizen, nor should we feel obliged to. But we feel obliged to offer basic services to felons, at least we could provide them to the rest of society. Advanced procedures to extend the lifespan of those with chronic organ dysfunction, like transplantation and dialysis should not be viewed as basic rights provided by the government, but a luxury, provided to those who can afford supplemental insurance.
I would much rather my tax dollars go towards the basic health care needs of those who cannot afford health care in the current flawed system than pay for their cell phone or cable service. In a system where we refuse no one in our emergency rooms, we essentially have universal emergency health care - those with health insurance pay more to make up the losses of the uninsured. The burden to pay for this is currently on our employers, and now being placed on individuals in addition to their taxes, albeit indirectly. If it were a part of Medicaid or similar program, employed individuals and corporations would pay less for their coverage, and we would be a better nation for providing basic care to all of our citizens. Our current attitudes towards entitlements in the country would have liberals screaming foul, asking how I could propose taking away dialysis and "killing" someone who cannot afford the treatment (forget the fact that other industrialized nations do not provide this treatment routinely). Conservatives, on the other hand, have seen so many well intentioned endeavors aimed for the betterment of society turned into beaurocratic nightmares, wasting billions annually. I really think it is the right thing to do in a nation as wealthy as ours....shame we don't have a leader who could pull both sides together on this issue.
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Americans will always have something to complain about. Health care will always be expensive in America, if we keep allowing doctors to get sued for millions.
The two aren't even comparable; fresh groundwater is a limited resource which in most cases is controlled by a municipal corporation. These monopolies usually sell the water at prices *far in excess* of their costs: the difference is usually used by municipal governments as a variable tax stream that doesn't require input from the voters.
The only limitations to healthcare are state imposed rules as to who can provide said healthcare and who can "practice medicine" as well as school imposed rules on who is allowed to get a medical education.
When one artificially restricts the supply of a service while demand for said service is increasing, guess what happens to the price? Said another way, not everyone can afford the "best" healthcare, yet in our society, there are no other price points available. Hell, you don't even know what the price points are and have no rational way to shop for service. How many people would go buy gasoline at a station and *then* ask how much it cost to fill up?
You point to a major factor for why healthcare costs have spiraled in this country. Not only are patients not privy to the costs of service before they are treated, most don't care because they don't have to pay - or they pay a set copay which is only a fraction of the real costs. For nonemergent medical decisions, I wish there were more cost conscious decisions being made - an analogy might be getting your car fixed. Oftentimes, neither party knows how much it costs to fix it before they spend some time diagnosing the problem (cost 1 - which is a known quantity) and could be similar to the copay. After a diagnosis is made, my automechanic provides a list of options, typically 1- do nothing despite the risks that my problem will get worse, 2- fix said problem with a refurbished by very capable part (generic medication $100), or 3- what the hell, lets just take that slightly worn part off and put on a brand new one (fancy new prescription drug $500). If you had to chose out of your pocket, which would you chose. I would take the refurbished part (generic drug), and I think most Americans would make that same choice. Why should the government then pay for the fancy new part for every Medicaid patient. Why do we complain about healthcare costs when we all want that plan that provides fancy prescription drug benefits. If we want more choice, why dont we influence our employers to seek that out, heck why dont we remove the ties of healthcare coverage from employment and open a free market again so more options might become available. Just a thought.
Posted By: patrick henry
Date: 2008-01-30 15:12:47
Nothing should be given to you by the Federal govt but LIBERTY.
Health care is expensive do to the govt meddling in the affairs of doctors and patients on behalf of insurance companies. Read HMO Act of 1974
Free markets always cover the need. Supply and demand. Simple economics. Limited and restricted (Regulated) services or resources ALWAYS result in an increase in price.
OBTW we are not a rich country but a really really really broke and indebted country. 9.2 TRILLION dollar debt and 56 TRILLION dollar debt in regards to entitlements.
Under the BUSH administration public water ways have become unusable due to pollution by greater than 74% in 4 years, purely by cap and trade regulation. And my municipality provides drinking water, just like the municipality in my city provides free health care to anyone that claims they have no money or pro-rates the charge accordingly to their income. THE MUNICIPALITY not the Federal govt. Read the 10th Ammendment
Government is the Servant
We are the Masters
REPUBLIC NOT DEMOCRACY
LIBERTY or DEATH
Posted By: Walt Thiessen
Date: 2008-01-30 15:24:50
When you point out the fact that pricing isn't available to patients, you just barely begin to touch upon one of the true issues here. This current pricing avoidance system exists because too much power has been given to insurance companies by the Federal government. "Managed Care" has become the new government-mandated bureaucracy to make your medical decisions for you. If you truly want to empower the poor, you have to begin with removing regulations that take power away from the patient and put it in the hands of the insurance companies.
Also, your article completely fails to mention the fact that health care doesn't have to cost anywhere near as much as it does. The only reason it does cost so much, again, is Federal and state regulation. The FDA, for example, has had a horrible impact on pricing, in the form of prescription drug regulation. It now costs upwards of a billion dollars to get a new drug or therapy past the FDA guardians, so it shouldn't surprise anyone, including a health care practitioner like you, that prescription drugs are so darned expensive. After all, Merck et al have to pass all that horrific expense along to somebody. And if someone finds a new use for an old form of chemistry (such as has happened with hydrogen peroxide, for example), it can't get past the FDA because no one can patent it...and therefore no one can afford the inordinate amount of testing required to distribute it legally as a medical treatment. This insures that inexpensive treatments (due to their unpatentable nature) can never enter mainstream medicine, removing a key market method for bringing down prices (let along helping keep prices from rising).
Ever since the Medicare act was proposed in 1964 and passed into law in 1965, health care costs have risen like crazy. Before 1964, anyone could afford medical care (even the elderly). Remember, Medicare was initially created with intention of being only a supplement to existing health insruance, which the elderly were already able to afford. That is no longer true, and now most elderly are 100% dependent upon Medicare. This is the resulting net impact of government regulation on pricing. Medicare has helped make health care and health insurance unaffordable for the elderly.
Medicare provides a good example. It was created in 1965 to make it easier for the elderly to get health care. But by reducing the patient's out-of-pocket costs, it increased the demand for doctors and hospitals. It also reduced the supply of those services by requiring doctors and other medical personnel to use their time and attention handling paperwork and complying with regulations -- and looking for ways to circumvent these things. So the price of medical care rose sharply as the demand soared and the supply diminished.
As a result, the elderly now pay from their own pockets over twice as much for health care (after adjusting for inflation) than they did before Medicare began. Many older people now find it harder to get adequate medical service. Naturally, the politicians point to the higher costs and shortages as proof that the elderly would be lost without Medicare -- and that government should be even more deeply involved.
When Medicare was set up in 1965, the politicians projected its cost in 1990 to be $3 billion -- which is equivalent to $12 billion when adjusted for inflation to 1990 dollars. The actual cost in 1990 was $98 billion -- eight times as much.
Building in yet another form of welfare for the poor will do nothing to reduce pricing and will actually harm the poor (and everyone else) even more than we are already harmed. As with most forms of welfare, just as school loans have made the cost of higher education soar, so also will another program for the poor instead only help to drive the cost of health care up even faster for everyone...including the poor.
Dialysis is available in over 150 countries (see <a href="http://www.globaldialysis.com/centres.asp">globaldialysis.com</a>) and is a routine part of medicine in every first world country as well as most so called second world countries (Brazil, India, etc). I think it would be our own neighbors that would be crying foul no matter what their political philosophy. Our society has been there (see <em>They decide who lives, who dies: Medical miracle and a moral burden of a small committee</em>. Life Magazine. 9 November 1962:102–25) and I think very few people are keen to go back to those dark days but <a href="http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/the-issue-of-th.html">the discussion appears to be on the table</a>.</p>
patrick henry the preamble makes it clear that one of the main points is to "promote the general Welfare"; the tenth amendment doesn't change that. What would promote the general Welfare more directly than a sensible healthcare system?
"I would much rather my tax dollars go towards the basic health care needs of those who cannot afford health care in the current flawed system than pay for their cell phone or cable service."
I would much rather be able to use those tax dollars to voluntarily donate money to a private charity who provided those medical services to the truly needy for free or reduced cost, because a private charity sensitive to price changes in the marketplace (labor, materials, etc.) will always, ALWAYS be more efficient than a government bureaucracy in providing goods and services.
Too many individuals forget that centralized planning will always fail to distribute goods and services as efficiently as the (truly) free market. It does not matter if the service in question is health care or dry cleaning. Governmental intervention is what got us into this current health care mess, so adding more intervention is not going to make the situation any better, only worse.
Furthermore, just because the author is OK with having his money taxed away by the government and used for others, what about those who do not wish to contribute to such a program? Will they be able to opt out? Or, will the government force them to participate in such "charitiable" activities whether they personally support them or not? What if the goverment decides (as it has in the past) that abortions are to be covered under their medical services? As a pro-lifer, will my "charitable" tax money go towards funding abortions?
Well-intended as the author may be, he has forgotten that government by definition is about the use of force and coercion alone; that is why they get all the guns, tanks, and prisons and the common folk do not. The government is not and should not ever be a vehicle for altruism, because its very nature is the antithesis of true, voluntary charity.
If the Salvation Army cannot say, "Donate to our charitable cause or face imprisonment," then why should it be morally acceptable for the government to do that, regardless of what the charitable cause in question might be?
Lastly, let me applaud the author for expressing concern for others who are genuinely in need of health care services. I do not disagree with his sympathy, only the way he proposes to address the need identified.
Chad - I appreciate your point about the "forced" charity imposed by governments through taxation for altruistic measures. I have heard RP make a similar arguement in the debates saying that if they weren't forced to pay income tax, charitable donations would increase. I agree with that as well, but certainly not to the degree that we are paying now. Despite the inefficiency of government, it is able to provide services which charitable organizations are nearly certainly unable to provide (especially in socioeconomically depressed areas where the help is needed most).
I am enthusiastic about RP and freedom, but I wonder if my heart is more centrist than most on this forum, or if I just have yet to shed some entrenched "politically traditional" values. I do think that universal health care would be a great gift for society, at least for our nations children (shame CHIP had so much baggage attached). And it actually looks like we will be giving that gift, whether we like it or not, in the near future.
Bill - I have looked into it a bit more and yes, dialysis services are used quite frequently in the UK and Canada with more centralized health care systems. The prevalence of disease seems to be about 1/2 that of the US per capita, and that was an off the cuff example, which admittedly does not hold up when I think more about it. Thanks for the comment.
I wrote a similar article, you guys should check it out. What i think that the author has touched on is that there is a problem with health care called the tragedy of the commons. I am wondering how this concept translates into libertarian ideology. how is the problem "tragedy of the commons" addressed?
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