OpEd: The Nature of the Health Care Debate

The health care debate is the topic on many TV and Radio news and commentary shows and unfortunately many of them keep rehashing the same arguments and, to my mind at least, are not advancing the general discussion. One example comes from a recent ABC News “This Week” episode where the Right’s “Death Panels” are “refuted” as either “not being in the bill” or as being an extreme interpretation of the “End of Life Counseling” provision.

My sense of this is that the Right’s “Death Panels” come from neither of these reasons but instead has its genesis as an extension of the philosophy of how government run *anything* will work. In this article we will examine several claims and attempt to advance the argument beyond the current sticking points. However, unlike my other articles, this one is clearly an opinion piece. As you’ll see I’ll lay the ground work for how an article using the typical format here might be constructed, but this article will not include such research.

Let’s start with the Death Panels.
The Right says that “the bill” (whatever that is) will encourage euthanisia and/or denial of coverage for expensive end of life costs.
The Left says that this is a crazy interpretation of the End of Life counceling provision that recently was removed from the putative bill.
My conjecture is: It appears the Right says this from ideological principles and not from any specific provision in the bill. The belief is the economics of any government run program will eventually force the program to deny treatment (for cost control reasons) and thus will lead toward a more dire end of life circumstance than what we now experience. Furthermore our current system does not have this problem because free-market economics prevents this from occuring.
What’s not being discussed is:

  • do our existing insurance companies deny or restrict end-of-life care now? Fact is that many elderly are on medicare/medicaid and so are already on a government run program. It should be easy to see how many elderly are solely on medicare/medicaid and what sort of end of life treatments are currently denied.
  • do other countries with much more “socialized medicine” have anything like death panels? This is one of my pet-peeves, specifically most/all US news shows treat our issues as if they are the first time these issues have ever occurred anywhere in the history of the world. Fact is that many of the options we’re considering for our system already exist in other countries so if we want to see what a specific change to our system may look like all we need to do is find a country that’s already doing something similar and see how it works there.

Recommendation: The Left should stop saying the Death Panels comment is due solely to a crazy interpretation of the End of Life counceling provision and the Right should posit some arguments, that if proven true, would convince them that their ideological objections are not warranted in this specific case.

Claim: Public Option will lead toward the end of Private Insurance
An extreme simplification of the Right‘s argument is that Private Insurance can’t compete with “free” public insurance.
The Left says that the “bill” does not (directly) restrict private insurance.
My conjecture is: Even if there are private insurance companies on day two of a public option the Right feels that the economics of a public option will eventually lead toward private insurance going away.
What’s not being discussed is:

  • whether any other countries have a vibrant public and private health insurance options. (I believe Switzerland, Sweden and Germany have such, but am not (yet) certain.)
  • whether a similar example can be found in any industry. This is where the US Postal service example comes in. Not only do we have FedEx and UPS, but these companies started after the US Postal service was started. At least part of the reason for this is that the expense of the US Postal service is not “free”. If we created the US Postal service as a free service to any one in the US, where it would be paid for through our taxes instead of through postage stamps, then UPS and FedEx could not have been started. But because the US Post office charges you for what you ship it leaves room for other companies to compete with it. Similarly, a public option paid for by taxes probably would cause private insurance to die, but if its paid for in a mechanism similar to our current insurance system, then both can co-exist.

Recommendation: The Left should think beyond what the marketplace will look like on “Day two” and think how this legislation will affect the marketplace in a year or two. The Right should realize that competition can coexist with government services, it all depends on how that service is set-up and start advocating for the correct set-up and not to completely block the public option. Both should find examples that support their claims or refute the other side’s claims. When such examples are brought to the table it focuses the discussion on the issues and away from who’s ideology is “right”.

Claim: If there’s a public option my tax dollars will pay for others’ abortions.
The Right says: … Actually the claim is a fair summary of what the Right says, but they’re making huge assuptions which we’ll dig into in a moment.
The Left says: that there’s no provision for this in the bill but again this oversimplifies things.
My conjecture is: For the Right’s concern to be real we need a public option supported by taxes. But as we’ve discussed above that is unlikely, and if the Republicans would actually engage in the debate instead of stonewalling they might be able to ensure a public option will not be paid by taxes. But the Left saying that this is not in the bill is a bit disingenuous as 2/3rds of private insurance companies cover abortions, what sort of public plan would the Democrats push that would not include what the majority of the private insurance companies include? And here we get to a litmus test of how strongly the Right believes in this issue. If you are against tax dollars being used for abortions, are you currently getting your health insurance through one of these companies that cover abortions and if so, why don’t you switch to a different insurance company? Alternatively what is the difference between your insurance dollars covering abortions and your tax dollars covering abortions?
Recommendation: This is a real concern. At the end of the day a public option will either cover or not cover abortion and a public option will either be paid-by-all (think taxes) or paid-by-users (think postage stamps or social security). The Left should be honest about this and the Right should be honest about whether their current insurance provider covers abortions.

Claim: If we have a public option the government will take more of your money.
The Right says: The government is already too large and adding public health will make it even larger.
The Left says: The government option is the only way.
My conjecture is: All I care about is money out of my pocket. If the cost of my insurance premiums goes down and my “taxes” go up but by a smaller amount then I am actually better off. See my earlier articles, the US has the largest health care expense in the world, both on a per-person basis and as a percent of GDP. It should be easily possible to cover everyone in the US for less than what we are now paying if we can get our costs inline with the 2nd most expensive system, Luxembourg. I’m encouraged to hear President Obama say that a large fraction of this will be paid for by reducing costs, but I don’t think that goes far enough. All of it should be paid for by reducing costs.
Recommendation: Stop talking about whether it will make government bigger and start talking about how health care as a percent of GDP can be reduced. We have plenty of examples from other countries around the world. This can be done.

Claim: A low-cost public system will encourage bad behavior.
The Right says: Any sort of public subsidy will encourage people to ignore the financial consequences of their actions and lead them to act irresponsibly.
The Left says: …… I have not heard any engagement by the Left on this issue.
My conjecture is: I agree with the general Right philosophy here for many issues but not this one. Assuming it applies in health care also assumes that people only pay attention to financial motivation. Health is also a strong motivator. I seriously doubt more people will smoke or take up sky diving if their health care costs were free. It should be possible to verify this by pulling up these sort of statistics from countries that offer less personally expensive health care than the US does. Is there a correlation between free health care and poor lifestyles?
Recommendation: Refuting statistics should be found or the Left could counter on philosophical issues, health for money is the Right’s argument here.

Conclusion
When I hear the hyperbolic comments on both sides what I hear are people refuting the detailed facts of an argument but completely ignoring the overarching tone of the discussion. Q: “When did you stop beating your wife?” A: “I did not hit her today.” While this exchange may be factually correct no one can walk away from that exchange wondering how horribly the wife may have been beaten yesterday. The response answers a particular part of the question but completely ignores the larger issue. To drive the point home… Q: “I’ve heard that this bill will lead to the creation of Death Panels.” A: “There is no provision in this bill for anything remotely like Death Panels.” versus this exchange Q: “If we have a public option, how will the goverment avoid terminating health care for elderly as part of future budget cuts or lack of available resources?” A: “There is no provision in this bill for anything at all like Death Panels.” While those on the left might think the first exchange is a reasonable response, everyone should have some outrage at the 2nd answer. If we can all calm down a bit and try to say what we really mean and actually listen to each other we can probably solve this health care problem.

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