Thursday I wrote about the bureaucratic and cumbersome definitions being used in the text of HR 3200. Having thought about that, I think we would do well as a nation to establish clear definitions of our own for the key points on this issue – doing so would not only make it simpler to discuss what we want or oppose, but might also establish some common ground. To that end, I am presenting what I think are the root questions to this issue.
1. What is Health Care, anyway?
Health Care is one of those things that sounds plain to most people, but which can still trip folks up when they get into specifics. For most people, after all, they can take care of their ordinary health needs and in fact they do not like being told what to do on decisions that they consider personal, like nutrition, exercise, and recreational behavior. How many people have you met who agree that smoking is a bad idea but they do it anyway, that they agree they should lose weight but still have high-fat foods in their diet, for instance? People go a doctor for occasional check-ups or mild illness, when experiencing life events like pregnancy or trying to diet, emergencies like a heart attack, stroke, or for a serious condition like Diabetes or Cancer. So, it seems to me that there are these four categories make up Health Care for most people, and some of these categories will be important to only certain types of people.
2. Is this one debate or two? Is Health Care the same thing as Health Insurance, and if not, why are the two being mixed in this debate?
The Obama Administration speaks of “Health Care Reform” on two fronts; changing insurance rules and changing how medicine is practiced. But the Democrats speak of their plan as one action, as if the same measures which – so they say – will reduce costs will at the same time as improving medical care. Such a bold claim needs to be explained in depth, rather than simply asserted.
3. Does Health Care work well in America?
This is a key question in the debate. The plain fact is, medical care in the U.S. is pretty darn good. If you collapse in the street of any major city in the U.S, you can expect to be in an emergency room within 20 minutes in normal conditions. Diagnosis and treatment of Cancer, Heart Attacks, Trauma, Burns, and many other fields is unsurpassed.
4. Does the present Health Insurance system work well in America?
More than two out of three Americans have insurance coverage that they like. It would seem, then, that there are three areas of contention – how to provide satisfactory medical care for people who cannot find suitable private insurance, how to insure the availability of quality medical care going forward, and how to control rising medical costs. A proper discussion needs to cover this ground with consideration of all major perspectives.
5. Are private insurance companies a good thing or a bad thing?
Private insurance companies are routinely demonized for charging higher and higher premiums from customers, but rejecting valid claims in order to make unfair profits. Certainly there are individual companies which do this, but we should remember that every state has an Insurance Board which governs the conduct of insurance agencies, insurance agents must be licensed and the industry is well regulated. In addition, while many Americans are displeased with their automobile and home insurance, most are happy with their health insurance and do not want major changes.
Insurance was not originally meant to be mandatory. For decades the various forms of insurance, whether Life, Health, Vehicle, Home, Liability or Property, were made available as an option to hedge against catastrophic loss or expenses that could not be met under certain conditions. It should be noted that government requirement that all drivers must be covered by at least liability insurance has neither reduced the frequency of motor vehicle accidents nor the cost of such incidents; the requirement that homes bought on mortgage agreements must carry homeowner’s insurance has not reduced the number of claims made on such policies, nor slowed the growth of the cost of that insurance. It is, on the evidence of the history, absurd to imagine that requiring individuals to obtain health insurance or requiring all employers to provide it will in total improve the condition of health of the nation’s citizens, nor reduce cost. There is no evidence whatsoever from past experience to justify such a claim.
6. Would the government do a better job than private insurance companies?
Looking at the history of the VA Hospitals, Medicare and Medicaid, it’s very hard to imagine how replacing any private insurer with a government program would be an improvement. This is an area where proponents of the new plan need to explain how the waste, errors, and sheer corruption of the past would not simply be repeated on a much larger scale.
I would start a discussion with these six questions. It would be a nice change if even these initial starting points could be addressed.