This Ought To Be A Healthy Debate

So the President unveiled his health plan(s) to what I thought was an incredible display of bravery on the Republicans’ part, and I’m jealous. I remember what it felt like to torture the substitute teacher from the back of class, yelling out “you lie!” and holding up signs and so forth. These people are really exploring new boundaries in civil discourse. Talk about exercising their liberties—if Joe Wilson had been Cynthia McKinney, they’d have dragged him out of the Capitol in handcuffs. Often behavior is perceived in ways that have more to do with the perpetrator than the crime.

If the Democrats had been as vehement over the plan to invade Iraq as the Republicans are about health care reform, we’d never have gone to war. But then again, criticizing the President used to be treasonous merely by virtue of the office; now it seems like a lot of plain ol’ folks out there think Obama is committing treason merely by being the President.

So health care reform will be a valiant and pointless struggle, because the Democrats don’t need Republican support to pass the bill. In fact, the President ought to say to those Blue Dogs who think they’ll be vulnerable in the coming elections, “vote against it if you think your constituents won’t like getting health care, run as a maverick and see how far it gets you.”

And so, of course, a conservative Democrat comes out with a plan that does not include the public option, and the left is howling because it doesn’t go far enough while the right howls about the government taking over healthcare. At least we have achieved one great accomplishment already: making sure no one can ever propose a single-payer option ever again. It worked! Hooray! Idiots.

Let’s be clear. This is not about bringing down “costs.” I get sick to my stomach whenever people talk about the need to control healthcare costs, because if the problem were costs, the whole debate would be over already. The crisis is not about healthcare costs. It’s about healthcare prices. Medicare costs aren’t what’s bankrupting Americans, it’s the profit margins collected by for-profit medical care. When the government runs the plan, prices and costs are roughly equivalent—about 2-3% off. When a corporation runs health care, the prices are whatever they can get you to pay and the costs are as little as they can spend. The greater the gap, the more money the corporation and its employees make, typically about 30% (i.e., a gap 10-15 times larger than government-run healthcare).

Obama’s common-sense rules about requiring insurance companies to behave like human beings are great, but it will end up increasing prices unless there is a real public option. Insurers make money by eliminating risks; when it comes to healthcare, that means eliminating people from coverage. “But won’t insurance companies make more money because now they’ll be insuring tens of millions more people?” Not if those are the people who they have very carefully figured out are going to end up costing them money. Healthcare is expensive now and isn’t going to get any cheaper any time soon, no matter how much “cost-cutting” we engage in. If the government’s plans end up offsetting the losses by insurance companies who must now insure unprofitable patients, we’ll be lucky, but we all know that no matter what happens, prices for healthcare consumers will go up.

If you want a glimpse into the minds of the people you trust to run your healthcare, you should be watching the debate play out on CNBC or Fox Business Channel. There, it’s the poor beleagured insurance companies that are the victims, only trying to protect themselves from vicious, lying packs of diseased hustlers who sign up for insurance knowing that they have a preexisting condition. Insurance prices are going to go through the roof (just like they did in Massachussetts, where Romney instituted mandatory coverage) and we’re all going to get screwed, all because Obama wanted to make nice with people whose votes he does not actually need. Inelastic markets don’t work the same way elastic ones do, and nobody shops around for healthcare providers after their heart attack.

Repeat after me: a corporation cannot take the Hippocratic oath. Would you take your healthcare from someone who is barred from taking the Hippocratic oath? I’d rather not, entrez-nous, because it means that by definition they don’t have my best interests at heart. The incentives are misaligned; which is no surprise considering that we are the only Western nation that has an “employer-pays” system. I mean, sure, employer-pays would be a fine idea, if your employers were prohibited from firing you. But they’re not. These health plans were introduced as a substitute for wages in the postwar boom period, but now it’s clear that companies are no longer reaping any benefits from running their workers’ health insurance plans. And now we’ve gotten to the point where one sixth of America’s economy is holding the other five ransom.

If you want to make a meaningful compromise—that is, with the insurance and healthcare companies directly, as opposed to their stooges in Congress—take a page from the President’s playbook when dealing with a real sensitive issue; federally-funded abortions. With characteristic subtlety and nuance, Obama flat out said we weren’t ever going to cover abortions. Well, where does that leave people who need abortions? At the mercy of the market, I suppose, and that’s the idea I want to examine.

If the healthcare industry simply cannot bear to compete with government-run healthcare, it shouldn’t have to. Instead of including a para-governmental “public plan” in addition to the panoply of existing government health plans and having it compete with private health insurance, the government ought to assume control of some parts of healthcare ought right, and let private insurers compete for others as long as they meet federal guidelines.

I say this because as I watched the President chicken out on abortion, it occured to me that I feel the same way about New Age “medicine” as I suspect pro-life conservatives feel about Planned Parenthood. The thought of federal dollars going to fund acupuncture or healing crystal treatments makes me, well, sick. At the same time, if you listen to health care reform opponents, America has the best system in the world because everybody’s getting LasikTM surgery nowadays.

So, here’s my proposal: the government should cover all catastrophic illnesses and emergencies (like they do now anyway in ERs across the country), all surgeries and medications. Private insurers, coops, sewing circles, witch doctors and other HMOs would compete to cover doctors visits, wellness, testing and preventative care, but most importantly, all elective surgeries, all ‘non-traditional’ medicine, all vitamin supplements, placebos, palm readings, gender reassignments, urinalyses and tattoo removals. It’s not exactly single-payer, but it is unlike it enough to qualify as “unique,” which is much more important to politicians than whether or not it works.


Anything not encased in blockquotes is © 2018 D. J. Waletzky. This site runs Casual Insides 6, now based on Wordpress.