National Health Care

What are you afraid of?


National Health Care
Tue June 16, 2009
What are you afraid of?
Not long after I came to California I spent three or four years without health care coverage. I had two kids. I learned all sorts of tricks to get by. It was a horrendous time of home remedies, hit-or-miss medical research, cajoling information and the occasional diagnosis from a doctor at a party or a chance encounter. Relatively late in life I discovered the day job and I’ve got great coverage now, but the anxiety involved with going without insurance was good for about twenty or thirty points of diastolic pressure.

Of course the best reason to institute a government option to make 100% coverage possible is to keep health emergencies from turning into family disasters. Easing the anxiety of heads of households, however, is one of dozens of ancillary reasons to put a viable national health care program together.

The primary objection comes from the medical profession itself. It is not unreasonable for medical care providers to safeguard the kinds of incomes that can account for their professional expenses. My son will probably leave medical school the year after next three hundred thousand dollars in debt. You used to be able to retire on that kind of money. But doctors generally take this point of view only because they don’t understand economics.

No, that’s not quite accurate. They might understand economics if they ever thought about it. Which they generally don’t.

Here’s why national health care would ultimately be beneficial to doctors as well as patients:

In the scheme of things, people without medical insurance should generally be seeing a doctor more often and generating smaller bills for it. If you compile the Americans currently without health care into a single interest group – and this is making the unwarranted assumption, for the sake of argument, that only people currently without coverage would opt for a federal plan – then per capita health care does not cost very much at all. If you spread the cost across the entire community, and eliminate administrative costs for employees whose primary purpose is to uncover and eliminate illegitimate claims, then the cost to the community of each person’s coverage comes out to a bit less than typical HMO group coverage of the sort provided by an employer.

So if, out of twenty families in this group, one of them has to deal with a catastrophic illness in the course of a year – and this assumption as well is unreasonably high – then the cost to the entire group is easily manageable. If on the other hand all of these twenty families pay for medical care out of pocket, the cost to that one family is likely to be ruinous.

There is very little excuse for such costs to be assumed only by the family affected. Any family can be affected but in any given year very few will. And when somebody is so stricken – well, that's hardly socialism; thats what communities are for.

Thus, the community as a group benefit from the institution of public health care. But what about the caregivers?

Doctors worry that their (1) medical DECISIONS would devolve to the government and get out of doctors’ control and that (2) many people employed by INSURANCE COMPANIES would suddenly be out of work, and insurance plans in which doctors hold an interest – such as those owned by large HMOs – would go out of business and that (3) medical FEES could be capped arbitrarily at an unreasonable level.

By the numbers:

  1. Currently, major medical decisions have to be cleared in advance by a patient’s insurance carrier. These decisions are based not so much on medical necessity as on the cost to the company, and whether the patient (read “customer”) remains a viable cost-effective client. Prior clearance by Medicare, another government-operated health care program, is far easier and faster for a clinician to obtain than that of any private insurance carrier.
  2. Public option medical coverage would be an employment bonanza. Relieved of the expense of employee medical plans, companies could replenish employee pools lately decimated by diminished markets. In such an environment, no management or administrative casualty of a contracting insurance concern would have any trouble finding work. The more people who are unemployed, the smaller the consumer markets get. Its a self-fueling engine. As employment gradually rises again, so will markets recover and thus make more employment necessary.
  3. Now &nddash; medical fees. In an environment where large groups of people must pay for medical care out of pocket, fees must ultimately reach a ceiling artificially imposed by an increasing number of people who simply cannot pay. Even if fees continue to rise, collections cannot. First of all, with government-sponsored health care there’s no such thing as a patient in arrears. Second, every doctor is required by civil and moral law to treat the patient in front of him or her. Where many patients do not engage in preventive care and live under an out-of-pocket condition, payment for medical care ultimately has a ceiling imposed by market forces. Where fees are set uniformly and paid faithfully, costs can continue to rise naturally with more wiggle room than they would have otherwise. When a community is crippled by artificial constraints as a result of rising costs in a single market sector, economic gridlock is inevitable. When those constraints are eased, all sectors of the economy grow in a healthy manner.

When Medicare was finally established – following a campaign of political opposition comparable to that which has delayed public health care for so long – doctors’ incomes actually continued to increase gradually. The same market imperatives will continue under national health care. Medical care will continue to be increasingly necessary in a population whose median age is getting higher and whose lifespan is continually lengthening. It is these sociological and technological factors, not a new payment model, that will allow the medical professions and the overall community to continue to thrive. This is as it ever was.

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