Is there a Dr. in the House… or perhaps the Senate?

Unless you have lived under the most wonderfully sound proof rock for the last 12+ months you couldn’t have failed to have noticed the wee chat about the state of health care.  What I am sure started off as amicable meeting of grand fromages has escalated far beyond a little game of Dr.’s and nurses to a national debate with billions of dollars and peoples lives at stake.

In true BBC style I will always try to find the balance in every argument.  I endeavor to consider all topics from as many sides as possible, but this one is really testing me. Is it just me or don’t you just work out which system covers all of the people all of the time for the lowest possible cost? Is it really more complicated than that?

As someone who has spent all but the last year of my life living in the UK health care was never an issue for me.  If you are sick you see a Dr. if you break something you go to A&E (English ER), and if you are worried that you caught some tiny livestock then… well you get the idea.  At no point did I ever think that I couldn’t afford to go, or that I wouldn’t be treated. As a citizen of the UK it was one of the functions of my government to make me better, it never occurred to me that either they wouldn’t or that I was expecting too much.

As debate in the US has been raging as an imported mind I have been asked some wonderful questions with regards to health care.  Out of all of them though my favorite had to be the time that someone asked if it was true that when you get to a certain and then the NHS simply lets you die.  I think the age this person thought this happened was 65!  And this is the problem.  The debate has been taken to such extremes that people will believe anything.  There is no education on what the actual implications of a new system would be.  The only issues talked about are the cost and the number of people covered.  Where is the explanation? Why can people not be trusted with consequences of their choices? Why is it always a race to the bottom with those invoking the strongest most fabricated rhetoric winning?

I am not as it may initially appear a blind believer in a National Health Service for all.  A national system should not cover every form of treatment not matter the cost of each whimsical request by the patient, and there are inherent downsides to National Systems that can’t realistically be avoided.  For instance you may face longer waiting lists, you may not have technology that wasn’t launched 2 seconds ago but have to accept options that are 5 minutes old.  It is possible that you wont always have a private room that allows for the whole menu of sponge baths options, and yes, it may even be thought that perhaps your 3rd face lift and 4th tummy tuck are perhaps not the best way to spend tax payer money.  But let me tell you this, it will mean that the lady down the street doesn’t have to sell her house because she got cancer and can’t pay for the treatment, and your brother who through no fault of his own keeps getting made redundant can still gets the immunizations for his kids.  Plus Tina, your wife’s best friend wont be told that she has filled her quota of treatment and her insurance company has decided to cut her off with nothing to fall back on.

I am in no way advocating a system that lets the patient order of the treatment menu but I do believe that the richest country on the planet is being negligible to its citizens by not providing them basic no questions asked coverage.  Equally I am not saying that there is no place for insurance companies in a 21st Centenary system. I would strongly advocate a system that brings together both private and public money.  As a consumer you should have the right to pay for healthcare that gives you the little extras, but as a citizen you should have the right to a government funded safety net.  A two level system is only inherently wrong when one level has everything and the other has nothing.

Being such a divisive issue I know that some or perhaps most will disagree with this proposed system but before the arguments flow let me at least answer some of them:

1) The US has the best drug research programs in the world and without the incentive of profits companies won’t research.

This may or may not be true, but let me ask you how many of the newly researched drugs are actually new and how many are simply adaptations of existing products.

Under a nationalized system the government becomes the most import client of any drug company.  If the government says research disease X they will.

I would also like to know what you as an individual get from all this research you are paying for.  Is it cheaper drugs for yourself, or is there a reason you can’t import from Canada?

2) A nationalized system is too big and will be over run by inefficiency and bureaucracy.

This is totally and utterly true.  Big nationalized systems are nearly always inefficient and will almost without fail be wrapped beautifully in red tape.  They are however still the best way to manage certain projects as on balance the positives out way the negatives.  If you don’t feel this way I urge you to petition your Congressman to abolish the US Army and in its place have purely private contactors.

3) A nationalized system will cost more than the current system.

The figures are all over the chart as to the exact amount each household pays per year but I would say that an estimate of $15,000 seems to be a good guide, and while I don’t know how much a nationalized system would cost I must ask a) did you get you $15k’s worth last year from your insurer and b) if you did, where did K street find all its lobbying money from?  By the way, that doesn’t include premiums you also have to pay on top of your insurance and if my limited knowledge is correct that is about 20% or more of every bill you are given.  When looking at cost you should also balance other factors such as economies of scale and standardization efficiencies.  Not everything a about being big is bad!

Looking past the negatives I would like to suggest potential positives beyond the basic like of like dollar cost of health single payer ‘V insurance companies.

1) Dynamic labor forces – By reducing the cost of employment to businesses you are encouraging employers to hire a more flexible workforce.  With the burden of health taken off the table you are encouraging a more fluid labor force that can better react to changes in the labor market.  An employee can choose to work multiple part time jobs instead of one fixed job without concern over their insurance coverage.  Options are given to both employer and employee that previously weren’t possible.

2) Information breeds knowledge – A centralized network of patient data with equal access at all points would allow information to not only be access far quicker but could allow for better research in to tends and patterns on a national level.  Fail safes over patients data rights and fails safes would have to be developed but a nationalized health system could give potential research data that otherwise would not be possible.

3) Dr’s can say no – It may just be a personal perception but I get the feeling that every time a patient sees a Dr they must return with justification of their visit to show their insurance company.  By removing the insurer a Dr. my feel more encouraged not to prescribe possibly unnecessary scripts. This could have the effect of reducing the spread of super bugs that are staring to build tolerance to commonly distributed antibiotics.

4) An equal chance – By ending the policy of the best Dr. charges the most and only the best insurance can pay for them you can introduce a degree of equality into the system.  All will have the chance to see the best as access will no longer be determined by the highest bidder but can be decided of the most appropriate case.

So what are we left with? Are we going to see this great debate bring about the change that is need? Not a chance. As I write this we are the House have passed their version of the bill and the Senate have also passed theirs.  We now also have in play the compromise White House proposed bill which is a melding on House and Senate, which I believe is being voted on in a couple of days.  So how do I know it wont work? Simple, it is a patch job, and wonderfully lobbied band-aid that is designed to bend no one out of shape while ensures that the issue is taken of the political table.  Both left and right will walk away claiming victory and the public will be the loser.  To the left they will claim that they have covered X number more people and that is a good thing, they will say that the system will be better than when they found it, all this may be true.  The right on the other hand will smile and let the left take their bow because they will know that they did their job.  They will still have helped their big insurance donors and they will have stopped the progressives and their desire for real change.  Status quo will be maintained and all will be well as everything will be just as they left it.

So how to end this (very long, and thank you for sticking with me) rant over one the hot button issues of the day? Perhaps, with a final appeal before it’s all too late:

Dear Mr. President,

I did not vote for you because I couldn’t but I did argue your case to anyone who would listen.  Why are you now making me look like a fool?  I beg of you, do not try to pass this shoddy, weak willed excuse for legislation.  You will look back and realize all you actually achieved was destroying any chance for real change in your life time.

I understand that you will take a massive personal political hit and it may well cost you the White House but go fighting for something that you can believe not this excuse for a compromise.  I urge to re-write your own proposal and instead of taking a little from the left and a little from the right simply formulate a coherent position that ensures a single payer system for all citizens.  Declare that this is what shall be voted on because no other solution is satisfactory and everything else is a half assed attempt at a subject that is too important and affects to many lives.  At worst you will loss the next election and healthcare will remain the same, but at least this way you will not dame millions of Americans to a life with no possibility of real coverage.

There is very little that I can be sure of but this I can tell you.  If your current compromise is passed, or anything like it there will not be another debate on this issue in your life time, there will simply be no political will to take the risk.  You will have created the 3rd.1 rail to go along with Social Security… There are 2 seconds on the clock, your are 2 points down and you have the ball at the top of the arch.  Are you really going for the lay-up and see what happens in overtime? Or would you take the shot because you have conviction in your abilities and you have the opportunity to make a difference, because time is nearly out and you are the one holding the ball.

Mr. President you are a man of history.  You understand both how it has brought you to this point and how it will judge you in the future.  More than 60 years ago the Liberals in Britain faced the same arguments you do today and against very similar conservatives opposition.  In every election and budget since for its entire life span the NHS has been seen as a massive expense, but it is never debated not even by the original conservative objectors as an institution that should be closed.  No politician could ever vote against giving its people a strong health system, they would be destroyed in every poll at every level of government.   Why is that you feel that denying your citizens the same coverage will make you fare any better come election day?

You did not create this situation and you have had very little help up to this point, but you wanted the job and now is the time to show why you deserve it.  It is time to decide Mr. President between rhetoric and action because you have to ask yourself, what will you be remember for in 60 years time?  Will history way heavy on your not just on your shoulders but on your conscience as well?

Yours with Sincerest hope,

A. Non. American


Posted on February 23, 2010, in Uncategorized. Bookmark the permalink. 1 Comment.

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