Health Care Debate

I rarely get political on this blog.  I think I can count two posts that might be seen as having political overtones.  And this will be the third, though for me, it has nothing to do with being a democrat or a republican, a liberal or a progressive or a conservative or right-wing extremist.  It has to do with health care, and what our goals should be. It seems to me that most discussions between the two sides of our very polarized country break down because we start with different premises.  Case in point:  the second amendment.  There is a legitimate debate about exactly what the "founding fathers" meant when they stated:  "A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed."  Most gun proponents look at the second part -- "the right of people to keep and bear Arms, shall not be infringed."  They therefore assume that they have the RIGHT to own any type of weapon that is manufactured, as long as it can be classified as "Arms."  Others look at the first part of that quote -- "A well regulated Militia, being necessary to the security of a free State..." -- and see that right to bear arms as being limited to their participation in a militia, say, the National Guard.  Still others look at the quote, written over 240 years ago, and believe that if the founders had an inkling of what would develop in weaponry -- things like assault rifles and grenade launchers and ammo that could punch through the thick metal bodies of tanks (which were also unimaginable to them, certainly, in present form), they would have wisely incorporated some limits. The point isn't what is right or wrong about the second amendment, it's that when we start with different premises, we will never agree. So the trick is to find a common premise and that may indeed be a difficult trick.  So let's start with this.  Is health care a right?  If so, at what level?  And if not, how do we deal with the health issues of those who can't afford to pay for their care? For example, I start with the premise that some basic level of health care should be accessible to all Americans.  I see that access to affordable health care at some level as a right.  Others do not.  I'd love to hear their reasoning. I also see it as a reasonable penalty to pay some relatively small amount as a penalty for someone's choice to not pay for coverage, because if that person ends up in the hospital, be it because of disease or accident, they're not going to pay for it -- the rest of us are, in indirect ways like higher hospital costs and higher insurance premiums.  Others see that as an infringement on their own right to not buy health insurance.  Where does their right end?  Does it end when that choice ends up costing the rest of us a lot more money in terms of health care? Can we agree that an accident or a disease should not bankrupt a person or a family in order to pay for their health care costs?  That seems like a pretty low standard. If we can agree that the above is a reasonable thing, then we have to decide how to achieve it.  I can tell you that lowering providers' reimbursement will not work.  Sure, some physicians might be making inordinate amounts of money compared to an Amazon warehouse worker.  But who gets to decide how much money physicians, who have one of the most important jobs in the world, should be paid?  How much is enough?  I think it should be substantial.  I won't go into all the reasons here, but I do know that if I'm having surgery, I want the best trained and smartest person available doing that surgery, and so do you. So if providers' fees aren't going to be cut, where's this savings going to come from?  Everyone has different ideas.  Sometimes those ideas get put together into health care legislation, and an attempt is made to solve some of the problems.  But the people who were getting rich off of other people's misfortune might not like those solutions because some of them might cut into their profits.  And sometimes the goals of the people purchasing the insurance (employers and individuals) are at odds with the goals of those selling it (the insurance companies).  So nothing is ever going to be perfect. In a perfect world, we'd all be able to go to the doctor when we were sick and not have to worry about not being able to afford the care we need.  And isn't that what we should be striving for?  A perfect world?  We'll never get there, of course, but it should be a goal.  The goals of American society should include affordable and accessible health care for every American, whether they are rich or poor, sick or healthy.  When you need health care, you need health care.  There's no getting around it. Can we all agree on that premise?  It seems so logical to me, but perhaps that's because of my perspective as a family man, as a health care provider, and as a businessman who has employees.  Perhaps others have a different perspective on that premise.  Maybe there are those out there who don't see that goal as being part of a perfect society.  I'd love to know why if that's the case.  Please feel free to comment, anonymously, if you'd like.  (Just don't get abusive or disrespectful.) Because if we CAN agree on that premise, then we should see this new republican plan for what it is:  a BIG step in the wrong direction. *****

2 thoughts on “Health Care Debate

  1. Steven M. Moore

    Scott,
    I certainly agree on your premise. I even agree that health care providers (doctors, dentists, nurses, and so forth) should be paid fairly. But here are two things I’ll touch on here because I haven’t done so in my own blog:
    1) Not enough health care providers? There seems to be an effort to control the number of available care providers. Are admission numbers to medical and dental schools limited for other than infrastructure and pedagogical reasons? And, if there’s a lack of infrastructure or too few teachers, can we change that?
    2) Health care in rural areas? In Colombia, which I’m familiar with because I lived there for many years, a doctor’s first and required “internship” after becoming a new MD is a year of service in areas where there are few health care providers. Medical services in rural areas seem to suffer in the U.S. like they do in Colombia. Maybe what the Colombians do would help here too. (BTW, Colombia has a single-payer healthcare system.)
    These points just add to the complexity of the U.S. health care problem, of course.
    BTW, all this discussion should be apolitical and based on morality. Nicholas Kristof’s op-ed column in the NY Times today, “And Jesus Said Unto Paul of Ryan…,” focused on the moral aspect, but I’m sure it will be taken as political.
    Great post!
    r/Steve

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  2. Scott Dyson Post author

    Re: Service requirement. I think this would be a good thing to do, but I do know a lot of MD’s come out with significant debt to service and need to get right to it. People forget that health care providers are generally older when they get into practice, and have lost a number of earning years that high school and college grads have had to make money and maybe even save a few bucks. We’ve all seen the simulations of saving early between 18 and 26, and then saving every year from 27 on. The person who saved only till age 26 will be ahead financially by retirement, given the same amount of money saved annually. Top that off with the high levels of debt and the high expenses for liability insurance that MD’s have (dentists have the latter to a far lesser extent). Just deferring debt doesn’t really help. It just postpones our path to financial freedom (or whatever you want to call it).

    I had written before that I thought there really needs to be a paradigm shift in the practice of medicine; that it needs to change focus from a profession that is basically entrepreneurial to one that is rooted even more in service. Perhaps that goes for dentistry as well. With the added training, the high initial cost barrier to practicing on one’s own, and the high expenses of liability insurance (and I haven’t even mentioned the stress levels!) it won’t attract the best minds unless it compensates with a comfortable lifestyle (meaning a reasonably solid income) and lower costs to becoming a doctor.

    I have heard that admissions are limited, and I believe that they are. It’s very competitive to get into dental school because I think there’s only about 60 of them in the country. And they’re terribly expensive. And their standards can be (and are) pretty high. There are a lot more medical schools, but it’s still at LEAST as competitive, probably more competitive. I’ve known students who decided not to pursue the profession, instead opting for PA programs and such, simply because of the costs. I imagine that it’s a fine line to walk between opening things up and producing more physicians, and maintaining the quality of applicants. Because if the chairs are there in a given program, they will get filled with someone.

    It’s a difficult situation. I know from discussing with various MD’s that Medicare reimbursements are so low as to make it financially impossible to do certain surgeries. That isn’t acceptable. Yet that seems to be the focus of so many cost-saving ideas. Cut reimbursement rates. The profession is being destroyed by such thinking.

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