Michael Kinsey had a really good op-ed piece in the Washington Post today regarding the Obama Administration’s impending health care reform initiative. Mr. Kinsey focused specifically on the issue of whether federal reform will cause health care rationing. In other words, under the newly designed national healthcare system, would anyone (or everyone) be denied the maximium possible health care for certain diseases or conditions? It got me thinking about the whole health care reform issue.
As Mr. Kinsey points out, under today’s “libertarian” health care system, people certainly do get different levels of health care. The richer and more important you are, the more health care you get. Health care is rationed according to wealth, or according to whether you’re lucky enough to have a job that provides health insurance (and within that group, how good your health plan is). Obama’s health care initiative will basically socialize the health care system; not that the government will operate it as was tried in Britian and other nations. There will still be private doctor practices and hospital corporations and insurance companies involved. But the overall system will now be designed and regulated by the government. There will still be some room for capitalism, perhaps much room. But the federal government will now provide the overall “system design” and its playing rules.
Why should this happen? The best motivation is to give everyone access to an acceptable level of health care. There certainly are too many working-poor people today who don’t have health insurance, and only get treatment in the event of an emergency through hospital charity care. Obviously, they don’t get the same level of health care that President Obama or the president of Microsoft gets. Under the federal upcoming reform, everyone will have access to some basic level of health care.
The problem comes in as to what will or won’t be considered “cost effective” under the cost containment provisions of the new plan. The federal government will now have a whole lot of say as to what treatments can or cannot be provided (unless you are rich enough to afford any kind of treatment you want, whether or not it meets some “average effectiveness threshold”; thus, a multi-millionaire with a rare or serious disease with no sure treatment could still get a drug that has a 1 in 5 shot of working; but the average citizen could not).
That might not be any worse than it is for the majority of us who rely upon health insurance, and are subject to our insurance company’s decisions about what they will or won’t pay for. We’ve gone long past the days when the doctor was in charge and the insurance company just picked up the tab. Now the government is going to take over the treatment decision-making role played by insurance companies; how can that be any worse?
The problem is that the government is now running a national system which has to deliver health care at a cost that is acceptable to a majority of the public (i.e., without significantly raising taxes). As such, we’re now going to mix medicine with politics.
It certainly will burden taxpayers to give good healthcare coverage to the many poor families who cannot afford it. Obama hopes that he can keep the tax burden in check by wringing out efficiencies, via national standards for medical practice. These national standards will try to eliminate wasteful practices such as doctors ordering too many tests and bringing in too many specialists. As the article points out, there are plenty of studies showing that in cities where there are lots of expensive specialists giving lots of expensive medical tests, people are no better off in their health outcomes. Also, if everyone can get health care when their problems are still small, a lot of emergency care expenses can be avoided, saving lots of money.
The conservative opponents of a federal health care plan say that the places where things like this have been tried, such as Canada and England, governments have not been able to bring costs down far enough to avoid the massive tax increases needed to bring about universal and equal access to health care. To avoid such tax increases, those government supposedly begin to ration care. People have to wait a long time to see specialists and get high-tech treatments, if they are available at all. More and more treatments are limited or blacklisted; promising new innovations are not approved immediately. Wealthy people thus start using private clinics, more and more.
But since the market for innovative, speculative treatments would thus be limited, health care companies and drug manufacturers might cut back on their research and development efforts for new cures. The rapid technological progress that has occurred in the medical field over the last 40 or 50 years might slow down. Government would have to take over the R&D; effort in health care; could it be as effective and successful in healthcare innovation as private industry has been?
I myself honestly don’t know what to make of all this. Having seen government in action for over four decades and having worked for government for several of them, I’m not overly optimistic that Obama’s plan can accomplish its goal of providing health care that is at the same time effective, affordable, innovative and fairly distributed. Sometimes a government agency can “catch a groove” and do amazing things, like NASA in the Moon race era. But remember, that was followed by the NASA of the Space Shuttle age. If we get a Space Shuttle bureaucracy, then there could well be Orwellian consequences from our federalized health care system.
America will be taking a big risk, should President Obama get his health care plan enacted and implemented. Perhaps it’s worth the risk, given the unfair mess that health care has become, and given the many other nasty side-effects of a capitalism-driven health care system. America leads the world in coming up with life-extending and life-improving treatments, but the trade-off is that not everyone can afford such treatments; a lot of people can’t even afford basic antibiotics or heart medicine. Health care capitalists are famous for coming up with administrative mechanisms that make life more miserable (HMO’s; care “accounts” that require you to seek out the lowest-cost treatment options when you are weak and sick; pre-existing condition limitations; etc.); and also for spending lots of money on marketing and advertising. Then add in all those crazy tests and specialist referrals that your neighborhood doctor orders in fear of malpractice lawsuits, and the whole thing starts to look like a real burn-out.
The free market hasn’t come up with anything to make it better for everyone. So the Obama government is now about to administer its treatment; a lot of good can be done, but there’s also an awfully big downside risk from politicizing the health care field. Let’s hope and pray that the politicians and bureaucrats can somehow stick by the doctor’s prime directive: i.e., “first, do no harm”.
Jim,
I must confess to mixed feelings about health care reform. I certainly can see the issue is open to many, many possible problems—OR for that matter, it could be the perfect solution to the health problem in the U.S. But likely, since most solutions to solve one problem contain within them problems of their own, this one will have its own problems that arise as/if it ever comes to realization.
However, some tho’ts on my part: First: I wonder about the question about “everyone be[ing] denied the maximum possible health care for certain diseases or conditions”. Frankly, I don’t think we have that situation pertaining right now—no one now receives the maximum possible health care at all times; and “certain diseases and conditions” are the areas that most truly fail in the “maximum possible health care” category.
For instance: Recently, I have read that Steve Jobs received a liver transplant. I have also read that, while he undoubtedly was very ill, the fact that he was RICH greatly improved his chances of receiving the transplant he needed. Specifically: It seems that a person needing a transplant is allowed to get on more than one list of patients requiring specific transplants. The only condition concerning being on such multiple lists is that the person be able to BE AT the place where the transplant will take place within a few hours. Thus, having either one’s own plane to take one any distance and/or being able to pay for a private charter (approximately $5000 I read) is a great help in receiving maximum health care. Thus, anyone without necessary funds would be automatically locked out of such a possible advantage in getting a liver transplant. I wonder how many people just as ill as Steve Jobs are still waiting for such transplants that will never come—simply because they do not have either a private jet and/or the funds to charter one.
As to the “cost effective” and “cost containment” problems of the new plan and the “federal gov’t” now having a “whole lot to say as to what treatments can or cannot be provided”: I wonder just what is the difference between the Feds having the last word on who can get what treatment or the insurance company doctors having the last word on who can get what treatment. In fact, I can see a possible advantage to the Feds having the last word as (sometimes I think) nothing is worse than the greed that arises from the “bottom line” concerns of for-profit insurance companies.
Then too: I have to say I simply disagree with your contention that the “doctor” is in control of a patient’s treatment. I say the patient is in control of what treatments the patient will or will not accept. I simply am not one who submissively says “yes, doctor” to every treatment/test, etc., a doctor may consider necessary. And I have disagreed with doctors over the necessity for a test/treatment and regretted it when I gave in to the doctor’s “better” judgment.
MCS
Continued next comment
Comment by MCS — June 28, 2009 @ 1:34 pm
Jim,
I must confess to mixed feelings about health care reform. I certainly can see the issue is open to many, many possible problems—OR for that matter, it could be the perfect solution to the health problem in the U.S. But likely, since most solutions to solve one problem contain within them problems of their own, this one will have its own problems that arise as/if it ever comes to realization.
However, some tho’ts on my part: First: I wonder about the question about “everyone be[ing] denied the maximum possible health care for certain diseases or conditions”. Frankly, I don’t think we have that situation pertaining right now—no one now receives the maximum possible health care at all times; and “certain diseases and conditions” are the areas that most truly fail in the “maximum possible health care” category.
For instance: Recently, I have read that Steve Jobs received a liver transplant. I have also read that, while he undoubtedly was very ill, the fact that he was RICH greatly improved his chances of receiving the transplant he needed. Specifically: It seems that a person needing a transplant is allowed to get on more than one list of patients requiring specific transplants. The only condition concerning being on such multiple lists is that the person be able to BE AT the place where the transplant will take place within a few hours. Thus, having either one’s own plane to take one any distance and/or being able to pay for a private charter (approximately $5000 I read) is a great help in receiving maximum health care. Thus, anyone without necessary funds would be automatically locked out of such a possible advantage in getting a liver transplant. I wonder how many people just as ill as Steve Jobs are still waiting for such transplants that will never come—simply because they do not have either a private jet and/or the funds to charter one.
As to the “cost effective” and “cost containment” problems of the new plan and the “federal gov’t” now having a “whole lot to say as to what treatments can or cannot be provided”: I wonder just what is the difference between the Feds having the last word on who can get what treatment or the insurance company doctors having the last word on who can get what treatment. In fact, I can see a possible advantage to the Feds having the last word as (sometimes I think) nothing is worse than the greed that arises from the “bottom line” concerns of for-profit insurance companies.
Then too: I have to say I simply disagree with your contention that the “doctor” is in control of a patient’s treatment. I say the patient is in control of what treatments the patient will or will not accept. I simply am not one who submissively says “yes, doctor” to every treatment/test, etc., a doctor may consider necessary. And I have disagreed with doctors over the necessity for a test/treatment and regretted it when I gave in to the doctor’s “better” judgment.
MCS
Continued next comment
Comment by MCS — June 28, 2009 @ 1:34 pm
Continued from previous comment:
I can see your point about mixing medicine with politics in a situation where the gov’t runs a “national system which has to deliver health care at a cost that is acceptable to a majority of the public”. However, I find myself wondering if that is as bad as an insurance company that advertises how it’s only, unselfish care is for the individual, when the real issue for the insurance company is the bottom line. (I cite the case with Cigna a few years back in which a member of my family had enormous problems with that company to get MINIMAL care she needed. And the “fuss” needed to appeal, etc., when the person is ill makes one wonder is it is all worth it and one is tempted to just submit oneself to fate.)
And I have to say that the argument that “health care companies and drug manufacturers might cut back” on their R&D; for new cures makes me wonder and consider a comparison to the oil companies. Do not the oil companies make the very same argument: they must have money for searching for other possible ways to find more oil. Yet, I find myself wondering just how it is that at the start of the month of May this year (and last if I recall correctly) oil prices jumped a huge amount. One day the price seemed somewhat reasonable—in the low $2 range, if I remember correctly; the next day (or so it seemed to me) the price was in the very high $2 range, if not $3 range. Please! The oil companies just raised the prices because they could and because people were traveling at this time of year. So, I tend to take with a grain of salt the “we-need-money-for-R&D;-we’re-so-altruistic argument, coming from ANY for profit company.
Yes, America is taking a “big risk” in going along with Obama’s health care plan. But I say life is full of risks; being afraid to take a risk is GROWTH-LIMITING to the human person and to a nation. Taking the step(s) involved in a risk requires a careful, well-thought-out consideration, serious study of the situation. I must say I see just that quality(ies) in Obama—that he carefully considers the situation, asks for the opinions and thoughts of those knowledgeable in the area under consideration, and then makes a thoughtful, considered decision—very much UNLIKE our previous president.
The worst thing, as I see it, for the growth of the human person—and in this case the growth of the NATION—is FEAR; the fear to take a risk.
Undoubtedly, there will not be a “magical” solution to the problem; there never are such solutions to any problem. Yet, if anything is to be done with the health care system, and it seems something MUST be done, then I’d rather see the situation in Obama’s hands; I say give him a chance to see what he can do.
MCS
Comment by MCS — June 28, 2009 @ 1:35 pm
Continued from previous comment:
I can see your point about mixing medicine with politics in a situation where the gov’t runs a “national system which has to deliver health care at a cost that is acceptable to a majority of the public”. However, I find myself wondering if that is as bad as an insurance company that advertises how it’s only, unselfish care is for the individual, when the real issue for the insurance company is the bottom line. (I cite the case with Cigna a few years back in which a member of my family had enormous problems with that company to get MINIMAL care she needed. And the “fuss” needed to appeal, etc., when the person is ill makes one wonder is it is all worth it and one is tempted to just submit oneself to fate.)
And I have to say that the argument that “health care companies and drug manufacturers might cut back” on their R&D; for new cures makes me wonder and consider a comparison to the oil companies. Do not the oil companies make the very same argument: they must have money for searching for other possible ways to find more oil. Yet, I find myself wondering just how it is that at the start of the month of May this year (and last if I recall correctly) oil prices jumped a huge amount. One day the price seemed somewhat reasonable—in the low $2 range, if I remember correctly; the next day (or so it seemed to me) the price was in the very high $2 range, if not $3 range. Please! The oil companies just raised the prices because they could and because people were traveling at this time of year. So, I tend to take with a grain of salt the “we-need-money-for-R&D;-we’re-so-altruistic argument, coming from ANY for profit company.
Yes, America is taking a “big risk” in going along with Obama’s health care plan. But I say life is full of risks; being afraid to take a risk is GROWTH-LIMITING to the human person and to a nation. Taking the step(s) involved in a risk requires a careful, well-thought-out consideration, serious study of the situation. I must say I see just that quality(ies) in Obama—that he carefully considers the situation, asks for the opinions and thoughts of those knowledgeable in the area under consideration, and then makes a thoughtful, considered decision—very much UNLIKE our previous president.
The worst thing, as I see it, for the growth of the human person—and in this case the growth of the NATION—is FEAR; the fear to take a risk.
Undoubtedly, there will not be a “magical” solution to the problem; there never are such solutions to any problem. Yet, if anything is to be done with the health care system, and it seems something MUST be done, then I’d rather see the situation in Obama’s hands; I say give him a chance to see what he can do.
MCS
Comment by MCS — June 28, 2009 @ 1:35 pm